Individual
RACHAEL MANNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
809 JEFFERSON AVE, LA PORTE, IN 46350-3431
(219) 617-4599
(219) 325-0855
Mailing address
809 JEFFERSON AVE, LA PORTE, IN 46350-3431
(219) 617-4599
(219) 325-0855
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004603A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200882550A
—
IN
01
—
M54203003
MEDICARE PTAN
IN
Enumeration date
05/16/2006
Last updated
09/01/2016
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