Provider Demographics
NPI:1063632370
Name:MANANSALA, ERLINDA M (EDD)
Entity Type:Individual
Prefix:DR
First Name:ERLINDA
Middle Name:M
Last Name:MANANSALA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 381632
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-1632
Mailing Address - Country:US
Mailing Address - Phone:617-876-6868
Mailing Address - Fax:617-876-2491
Practice Address - Street 1:675 MASSACHUSETTS AVENUE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-876-6868
Practice Address - Fax:617-876-2491
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6627103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
466764OtherVALUE OPTIONS
MAW05414OtherBLUE CROSS BLUE SHIELDS
MA0524379Medicaid
MAW05414OtherBLUE CROSS BLUE SHIELDS