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NPI Code Detail

MEDICARE: JEAN MANIS LCSW

MEDICARE: JEAN MANIS 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
11041C0700XClinical Social Worker34003337AIN

General Provider Information

NPI Number : 1275603532
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN MANIS LCSW
Provider Business Mailing Address
First Line : 431 WEST 9TH STREET
Second Line :
City : ANDERSON
State : IN
Zip : 46016-1317
Country : US
Telephone Number : 765-649-2234
Fax Number : 865-640-0538
Provider Business Practice Location Address
First Line : 431 WEST 9TH STREET
Second Line :
City : ANDERSON
State : IN
Zip : 46016-1317
Country : US
Telephone Number : 765-649-2234
Fax Number : 865-640-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 11/03/2016

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Directions to “ JEAN MANIS LCSW” Practice Location

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