Provider Demographics
NPI:1255469318
Name:MANER, JUDITH MILLER (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MILLER
Last Name:MANER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:MILLER
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:41 A LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3162
Mailing Address - Country:US
Mailing Address - Phone:404-264-0046
Mailing Address - Fax:404-237-6556
Practice Address - Street 1:41 A LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3162
Practice Address - Country:US
Practice Address - Phone:404-264-0046
Practice Address - Fax:404-237-6556
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW001584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBDJFMedicare ID - Type Unspecified
R71048Medicare UPIN