Provider Demographics
NPI:1225243215
Name:MANFREDO, IRENE TERESA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:TERESA
Last Name:MANFREDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 KILMER CT APT 4
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1717
Mailing Address - Country:US
Mailing Address - Phone:518-439-6512
Mailing Address - Fax:
Practice Address - Street 1:1 PINNACLE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-689-0244
Practice Address - Fax:518-689-0241
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
NYR063080-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical