Provider Demographics
NPI:1063507978
Name:MANNING, CARYN WACHS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:WACHS
Last Name:MANNING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PAVILION AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1534
Mailing Address - Country:US
Mailing Address - Phone:401-490-8972
Mailing Address - Fax:401-289-2280
Practice Address - Street 1:49 PAVILION AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1534
Practice Address - Country:US
Practice Address - Phone:401-490-8972
Practice Address - Fax:401-289-2280
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICW67499Medicaid