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General NPI Number Information
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NPI Number | 1821593237
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Entity Type | Individual
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Provider Name | EVAN MCMANAMY
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 433 BROADWAY
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City | PROVIDENCE
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State | RI
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Zip | 02909-1624
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Country | US
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Telephone | 401-680-0334
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Fax |
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Provider Business Mailing Address
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Address Line | 433 BROADWAY
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City | PROVIDENCE
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State | RI
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Zip | 02909-1624
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Country | US
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Telephone | 401-680-0334
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60845227
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT02510
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW02741
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License Number State | RI
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