Provider Demographics
NPI:1346213030
Name:MANZ, ALLYSEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLYSEN
Middle Name:
Last Name:MANZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1448
Mailing Address - Country:US
Mailing Address - Phone:917-293-7734
Mailing Address - Fax:212-806-0706
Practice Address - Street 1:130 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4306
Practice Address - Country:US
Practice Address - Phone:917-293-7734
Practice Address - Fax:212-806-0706
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical