Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS002739L | PA |
Y | 103TC0700X | Clinical Psychologist | PS002739L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS002739L | PA |
NPI | 1114928371 |
---|---|
Provider Name | Anthony P Mannarino |
First Address | Pittsburgh, PA 15212-5255 |
Second Address | Pittsburgh, PA 15212-5255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 09/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001448806 | (05) | PA |