Individual
MANNY PAULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE, TACOMA, WA 98431-2104
(253) 966-3266
Mailing address
829 S STATE ST, TACOMA, WA 98405-3041
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
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