Provider Demographics
NPI:1275609760
Name:NADEAU-MANNING, JULIE MARIE-ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE-ANNE
Last Name:NADEAU-MANNING
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 1:6160 MISSION GORGE RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3410
Mailing Address - Country:US
Mailing Address - Phone:619-282-2232
Mailing Address - Fax:619-282-2992
Practice Address - Street 1:4094 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2143
Practice Address - Country:US
Practice Address - Phone:619-515-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS254ZOtherMEDICARE PTAN