Provider Demographics
NPI:1275778417
Name:SHIPPENVILLE PROJECT POINT OF LIGHT, INC DBA MANNO THERAPEUTIC SERVICE
Entity Type:Organization
Organization Name:SHIPPENVILLE PROJECT POINT OF LIGHT, INC DBA MANNO THERAPEUTIC SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:814-226-1159
Mailing Address - Street 1:20231 PAINT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254
Mailing Address - Country:US
Mailing Address - Phone:814-226-1159
Mailing Address - Fax:814-227-2876
Practice Address - Street 1:20231 PAINT BOULEVARD
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254
Practice Address - Country:US
Practice Address - Phone:814-226-1159
Practice Address - Fax:814-227-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004041101YP2500X
PASW130013104100000X
PACW0171811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty