Provider Demographics
NPI:1003393869
Name:MARANA-MANCHESS, VIVIAN (BCBA, LBA, CASAC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:MARANA-MANCHESS
Suffix:
Gender:F
Credentials:BCBA, LBA, CASAC
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:MANCHESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA, LBA, CASAC
Mailing Address - Street 1:4732 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4732 41ST ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3646
Practice Address - Country:US
Practice Address - Phone:347-635-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)