MEDICARE: MARCELLA MANUEL LPC

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	104100000X	Social Worker	1256	LA

General Provider Information

NPI Number	:	1932172822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELLA MANUEL LPC

Provider Business Mailing Address
First Line	:	PO BOX 1254
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-1254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14514 LA HIGHWAY 92
Second Line	:
City	:	MAURICE
State	:	LA
Zip	:	70555-3044
Country	:	US
Telephone Number	:	337-893-6767
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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Directions to “ MARCELLA MANUEL LPC” Practice Location

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