Provider Demographics
NPI:1326605262
Name:MANNINGHAM, SCOTT RASHEED (MS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RASHEED
Last Name:MANNINGHAM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:RISKIE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3491 GANDY BLVD N STE 201
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2654
Mailing Address - Country:US
Mailing Address - Phone:216-254-1434
Mailing Address - Fax:
Practice Address - Street 1:3491 GANDY BLVD N STE 201
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2654
Practice Address - Country:US
Practice Address - Phone:727-547-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15710101YM0800X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health