Provider Demographics
NPI:1285686634
Name:MANNEY, RACHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MANNEY
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 1:809 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3431
Mailing Address - Country:US
Mailing Address - Phone:219-617-4599
Mailing Address - Fax:219-325-0855
Practice Address - Street 1:809 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3431
Practice Address - Country:US
Practice Address - Phone:219-617-4599
Practice Address - Fax:219-325-0855
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004603A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM54203003OtherMEDICARE PTAN
IN200882550AMedicaid