Provider Demographics
NPI:1073847117
Name:MANZI, MARILYN D (PSYCHOTHERAPIST LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:D
Last Name:MANZI
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SUTTER ST. UNIT 776
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-9020
Mailing Address - Country:US
Mailing Address - Phone:971-333-0623
Mailing Address - Fax:
Practice Address - Street 1:101 SW MADISON ST # 1934
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3264
Practice Address - Country:US
Practice Address - Phone:971-333-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1463106H00000X
CA107464106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist