Provider Demographics
NPI:1063005213
Name:ACOSTA-DUQUE, MANNYA S (LCSW)
Entity Type:Individual
Prefix:
First Name:MANNYA
Middle Name:S
Last Name:ACOSTA-DUQUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MANNYA
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:5400 POMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1717
Mailing Address - Country:US
Mailing Address - Phone:323-837-2133
Mailing Address - Fax:323-721-2437
Practice Address - Street 1:1085 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4112
Practice Address - Country:US
Practice Address - Phone:626-332-8138
Practice Address - Fax:626-332-0433
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1210391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical