MEDICARE: ANNA J MANZANO LCSW

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	13869	TX

General Provider Information

NPI Number	:	1093834970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA J MANZANO LCSW

Provider Business Mailing Address
First Line	:	66 CANDLE PINE PL # 100
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-6436
Country	:	US
Telephone Number	:	800-746-7284
Fax Number	:	936-273-3786

Provider Business Practice Location Address
First Line	:	201 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-5009
Country	:	US
Telephone Number	:	817-293-7610
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/09/2007

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