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General NPI Number Information
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NPI Number | 1821285677
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Entity Type | Individual
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Provider Name | STEVEN MICHAEL MANKAVECH LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 85 WESTSIDE AVE
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City | NORTH ATTLEBORO
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State | MA
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Zip | 02760-1424
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Country | US
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Telephone | 508-643-7430
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Fax |
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Provider Business Mailing Address
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Address Line | 110 LIBERTY ST
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City | BROCKTON
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State | MA
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Zip | 02301-5674
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Country | US
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Telephone | 508-894-0548
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2027017
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License Number State | MA
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