MEDICARE: CASSIE ELIZABETH MANNING B.S, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1268	NH

General Provider Information

NPI Number	:	1023871787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE ELIZABETH MANNING B.S, LADC

Provider Business Mailing Address
First Line	:	15 ELM ST APT A
Second Line	:
City	:	WOODSVILLE
State	:	NH
Zip	:	03785-1275
Country	:	US
Telephone Number	:	603-728-8904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-2042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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