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NPI Code Detail

MEDICARE: MRS. KATIE LOIS MCMANUS MSW, PPSC, LCSW

MEDICARE: MRS. KATIE LOIS MCMANUS MSW, PPSC, 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
11041S0200XSchool Social Worker439006HWA

General Provider Information

NPI Number : 1154514065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATIE LOIS MCMANUS MSW, PPSC, LCSW
Provider Business Mailing Address
First Line : 915 54TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94608-3142
Country : US
Telephone Number : 510-879-4619
Fax Number :
Provider Business Practice Location Address
First Line : 915 54TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94608-3142
Country : US
Telephone Number : 253-227-1961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2007
Last Update Date : 11/29/2022

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