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NPI Code Detail

MEDICARE: MRS. KIRA M MANTELL LCSW

MEDICARE: MRS. KIRA M MANTELL 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 WorkerDP00945238WV
21041C0700XClinical Social Worker0904009469VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10904009469OTHERVALICENSE

General Provider Information

NPI Number : 1447492632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIRA M MANTELL LCSW
Provider Business Mailing Address
First Line : 115 SUMMIT ST
Second Line :
City : SPENCER
State : WV
Zip : 25276-1140
Country : US
Telephone Number : 757-692-8081
Fax Number : 304-927-8198
Provider Business Practice Location Address
First Line : 512 HOUSTON ST
Second Line :
City : STAUNTON
State : VA
Zip : 24401-3525
Country : US
Telephone Number : 888-365-6271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 08/29/2019

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