Provider Demographics
NPI:1003513474
Name:MANELLA, ALLISON NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:MANELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 W BELMONT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2166
Mailing Address - Country:US
Mailing Address - Phone:312-508-3645
Mailing Address - Fax:312-971-8554
Practice Address - Street 1:311 W SUPERIOR ST STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3537
Practice Address - Country:US
Practice Address - Phone:312-584-2144
Practice Address - Fax:312-971-8554
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-05-16
Deactivation Date:2023-03-17
Deactivation Code:
Reactivation Date:2023-04-06
Provider Licenses
StateLicense IDTaxonomies
MO20220349161041C0700X
IL149.0252961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical