Provider Demographics
NPI:1255483129
Name:MCMANUS, ANGELA KATHRYN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KATHRYN
Last Name:MCMANUS
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:PO BOX 2418
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-2418
Mailing Address - Country:US
Mailing Address - Phone:850-830-8340
Mailing Address - Fax:
Practice Address - Street 1:4507 FURLING LN STE 212
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5343
Practice Address - Country:US
Practice Address - Phone:850-830-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical