Provider Demographics
NPI:1073942231
Name:MAGE, MANUELA PEREIRA (LCSW)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:PEREIRA
Last Name:MAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 79TH ST APT C8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3754
Mailing Address - Country:US
Mailing Address - Phone:301-204-2629
Mailing Address - Fax:
Practice Address - Street 1:601 79TH ST APT C8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3754
Practice Address - Country:US
Practice Address - Phone:301-204-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089087282N00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1231360OtherLICSW LICENSE