Provider Demographics
NPI:1205041324
Name:MANNI, JOHN L (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:MANNI
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9735
Mailing Address - Country:US
Mailing Address - Phone:215-822-3879
Mailing Address - Fax:215-822-3879
Practice Address - Street 1:809 BETHLEHEM PIKE
Practice Address - Street 2:BOX 129
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477
Practice Address - Country:US
Practice Address - Phone:215-643-7944
Practice Address - Fax:215-643-9543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002401L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist