MEDICARE: RACHEL ELLEN MANNE MSW, 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	25322	CA

General Provider Information

NPI Number	:	1326694753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ELLEN MANNE MSW, LCSW

Provider Business Mailing Address
First Line	:	18619 COLLINS ST APT F18
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-2170
Country	:	US
Telephone Number	:	949-842-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	7057 SHOUP AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-2335
Country	:	US
Telephone Number	:	818-348-8422
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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