MEDICARE: MRS. LATINA MCMANUS CSW

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	251S00000X	Community/Behavioral Health Agency
2	171M00000X	Case Manager/Care Coordinator		DC

General Provider Information

NPI Number	:	1659073914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATINA MCMANUS CSW

Provider Business Mailing Address
First Line	:	6008 MARDELLA BLVD
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2254
Country	:	US
Telephone Number	:	202-997-5030
Fax Number	:

Provider Business Practice Location Address
First Line	:	6008 MARDELLA BLVD
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2254
Country	:	US
Telephone Number	:	202-997-5030
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	07/31/2023

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