Provider Demographics
NPI:1114288156
Name:MUNRO, MANUEL G (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:G
Last Name:MUNRO
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:MR
Other - First Name:MANUEL
Other - Middle Name:G
Other - Last Name:MUNRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER, LMSW
Mailing Address - Street 1:4905 PARK AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-7216
Mailing Address - Country:US
Mailing Address - Phone:201-370-8005
Mailing Address - Fax:
Practice Address - Street 1:4905 PARK AVE
Practice Address - Street 2:2B
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-370-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090943104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY090943OtherLMSW