Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | B1-0001005 | DE |
N | 103TC0700X | Clinical Psychologist | B1-0001005 | DE |
N | 103G00000X | Clinical Psychologist | PS017616 | PA |
N | 103TC0700X | Clinical Psychologist | PS017616 | PA |
Y | 103G00000X | Clinical Psychologist | B1-0001005 | DE |
Y | 103TC0700X | Clinical Psychologist | B1-0001005 | DE |
N | 103G00000X | Clinical Psychologist | PS017616 | PA |
N | 103TC0700X | Clinical Psychologist | PS017616 | PA |
N | 103TR0400X | Rehabilitation Psychologist | B1-0001005 | DE |
N | 103TR0400X | Rehabilitation Psychologist | PS017616 | PA |
NPI | 1114298791 |
---|---|
Provider Name | Michelle Manasseri |
First Address | Newark, DE 19713-3467 |
Second Address | Newark, DE 19713-3467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2012 |
Last Update Date | 12/02/2015 |