Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | ||
N | 1041C0700X | Clinical Social Worker | 23542 | CA |
Y | 1041C0700X | Clinical Social Worker | 3860 | HI |
NPI | 1043549637 |
---|---|
Provider Name | Mrs. Shanti Kay Manzano |
First Address | Koloa, HI 96756-1075 |
Second Address | Koloa, HI 96756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2009 |
Last Update Date | 04/03/2019 |