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General NPI Number Information
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NPI Number | 1720765035
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Entity Type | Individual
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Provider Name | GUY-MANNO CINE LBS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 6136 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3430
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Country | US
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Telephone | 267-581-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 6136 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3430
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Country | US
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Telephone | 267-581-4081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | BH006395
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License Number State | PA
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