MEDICARE: CHERIE G. MANNINO L.I.S.W.

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	1041C0700X	Clinical Social Worker	I.0700063	OH

General Provider Information

NPI Number	:	1053599837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIE G. MANNINO L.I.S.W.

Provider Business Mailing Address
First Line	:	5596 CLOVERDALE DR
Second Line	:
City	:	GALENA
State	:	OH
Zip	:	43021-9552
Country	:	US
Telephone Number	:	614-446-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 S LIBERTY ST
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-7619
Country	:	US
Telephone Number	:	614-446-0225
Fax Number	:

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	06/15/2016

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