Healthcare Provider Details

I. General information

NPI: 1306925995
Provider Name (Legal Business Name): MANFRIED KARL ZEITHAMMEL DIPLOMATE, SOC WRK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 F ST W
RANDOLPH A F B TX
78150-4536
US

IV. Provider business mailing address

1010 EAGLE CREEK DR
FLORESVILLE TX
78114-9206
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-5321
  • Fax: 210-652-3166
Mailing address:
  • Phone: 830-393-0293
  • Fax: 210-652-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number034350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: