Healthcare Provider Details

I. General information

NPI: 1669758124
Provider Name (Legal Business Name): ANITA MANCINI-MICHELL PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 S NEW BRAUNFELS AVE STE 100
SAN ANTONIO TX
78223-3005
US

IV. Provider business mailing address

6711 S. NEW BRAUNFELS STE 100
SAN ANTONIO TX
78223-3002
US

V. Phone/Fax

Practice location:
  • Phone: 210-532-8811
  • Fax: 210-531-8172
Mailing address:
  • Phone: 210-532-8811
  • Fax: 210-531-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: