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General NPI Number Information
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NPI Number | 1962879429
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Entity Type | Individual
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Provider Name | ALBA MANALASTAS HIDALGO MSS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 336 LINCOLN AVE
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City | PROSPECT PARK
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State | PA
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Zip | 19076-2421
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Country | US
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Telephone | 267-331-0893
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Fax |
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Provider Business Mailing Address
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Address Line | 336 LINCOLN AVE
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City | PROSPECT PARK
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State | PA
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Zip | 19076-2421
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Country | US
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Telephone | 484-427-4673
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW130090
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW018712
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State | PA
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