Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 18017 | NY |
Y | 104100000X | Social Worker | 094736-1 | NY |
NPI | 1003336074 |
---|---|
Provider Name | Marie Elizabeth Manley |
First Address | Jamaica, NY 11433-1608 |
Second Address | Jamaica, NY 11433-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 21/06/2017 |