Provider Demographics
NPI:1093834970
Name:MANZANO, ANNA J (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:J
Last Name:MANZANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MANZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:66 CANDLE PINE PL # 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6436
Mailing Address - Country:US
Mailing Address - Phone:800-746-7284
Mailing Address - Fax:936-273-3786
Practice Address - Street 1:201 SYCAMORE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-5009
Practice Address - Country:US
Practice Address - Phone:817-293-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83883WMedicare PIN