Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 103K00000X | Behavior Analyst |
NPI | 1003393869 |
---|---|
Provider Name | Vivian Marana-Manchess |
First Address | Sunnyside, NY 11104-3646 |
Second Address | Sunnyside, NY 11104-3646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 24/07/2018 |