MEDICARE: DR. JEAN ELLEN MANNINO PH.D.

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	103TC0700X	Clinical Psychologist	PSY 4449	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 4449	CA

General Provider Information

NPI Number	:	1881721421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN ELLEN MANNINO PH.D.

Provider Business Mailing Address
First Line	:	3007 CURLEW ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5535
Country	:	US
Telephone Number	:	619-291-2009
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 CURLEW ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5535
Country	:	US
Telephone Number	:	619-291-2009
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/11/2025

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