Individual
MANNY PAULA
Active
Individual
MANNY PAULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
123675
MA
1041C0700X
Clinical Social Worker
224111
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110171759
—
MA
Enumeration date
06/21/2019
Last updated
11/22/2024
Update your record
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