MEDICARE: DR. BREA ANN MANETTA 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	103T00000X	Psychologist	2568	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018336	OTHER	CO	VALUE OPTIONS
2	2270399	OTHER	CO	CIGNA
3	MA658563	OTHER	CO	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7079467	OTHER	CO	AETNA

General Provider Information

NPI Number	:	1932243011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BREA ANN MANETTA PH.D.

Provider Business Mailing Address
First Line	:	19 OLD TOWN SQ
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2471
Country	:	US
Telephone Number	:	970-391-0629
Fax Number	:	970-482-0251

Provider Business Practice Location Address
First Line	:	19 OLD TOWN SQ
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2471
Country	:	US
Telephone Number	:	970-391-0629
Fax Number	:	970-482-0251

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	10/23/2008

Similar Medicare Providers

1710743463 — ASHLYN DOTY LPC
Practice Location Address:

19 OLD TOWN SQ STE 238
FORT COLLINS, CO
80524-2471

Practice Phone: 970-409-4020
Practice Fax:

1386651701 — DR. LINDA T BAUM EDD
Practice Location Address:

19 OLD TOWN SQ
FORT COLLINS, CO
80524-2471

Practice Phone: 970-225-1684
Practice Fax:

1699862789 — JENNIFER ROBERTS PHD
Practice Location Address:

19 OLD TOWN SQ
FORT COLLINS, CO
80524-2471

Practice Phone: 646-526-3116
Practice Fax: 970-482-0251

1750425831 — DR. MARTHA STEVE SUTHERLAND PSYD
Practice Location Address:

19 OLD TOWN SQ STE 238
FORT COLLINS, CO
80524-2471

Practice Phone: 970-587-8929
Practice Fax:

1558557843 — MARTHA SUTHERLAND, PSYD, PLLC
Practice Location Address:

19 OLD TOWN SQ , SUITE 238
FORT COLLINS, CO
80524-2471

Practice Phone: 970-587-8929
Practice Fax:

1356677090 — MS. BARBARA LYNN BEACH L.P.C., NCC
Practice Location Address:

19 OLD TOWN SQ , SUITE 238
FORT COLLINS, CO
80524-2471

Practice Phone: 970-217-7124
Practice Fax: 970-224-5674

Directions to “ DR. BREA ANN MANETTA PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.