Provider Demographics
NPI:1063632263
Name:MANZER, SHIRLEY A (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:A
Last Name:MANZER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HORSEBACK RD
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:ME
Mailing Address - Zip Code:04911
Mailing Address - Country:US
Mailing Address - Phone:207-717-4896
Mailing Address - Fax:
Practice Address - Street 1:78 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976
Practice Address - Country:US
Practice Address - Phone:207-858-4860
Practice Address - Fax:207-858-4864
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS5981171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator