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General NPI Number Information
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NPI Number | 1295374478
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Entity Type | Organization
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Legal Business Name | MICHAEL MANCILLA LICSW
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Dates
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Enumeration Date | 01/05/2020
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Last Update Date | 01/05/2020
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Provider Practice Location Address
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Address Line | 1629 K ST NW STE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1631
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Country | US
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Telephone | 202-234-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 437 NEW YORK AVE NW APT 211
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City | WASHINGTON
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State | DC
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Zip | 20001-4746
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Country | US
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Telephone | 202-234-2299
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MR. MICHAEL A MANCILLA
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Credential | LICSW
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Telephone | 202-234-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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