Provider Demographics
NPI:1225110430
Name:MANZELLA, JAMES A (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MANZELLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 MARY ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2280
Mailing Address - Country:US
Mailing Address - Phone:412-488-8102
Mailing Address - Fax:412-488-0166
Practice Address - Street 1:2250 MARY ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2280
Practice Address - Country:US
Practice Address - Phone:412-488-8102
Practice Address - Fax:412-488-0166
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0146871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA348865OtherHIGHMARK PIN
PA084305KX2Medicare PIN