Provider Demographics
NPI:1194035063
Name:MANCINO, SUSAN M (MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MANCINO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 YOSEMITE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5335
Mailing Address - Country:US
Mailing Address - Phone:831-566-3447
Mailing Address - Fax:
Practice Address - Street 1:84 YOSEMITE AVE APT 6
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5335
Practice Address - Country:US
Practice Address - Phone:831-566-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist