Provider Demographics
NPI:1376604157
Name:MCMANUS, PATRICIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MCMANUS
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 1:53 RIVER ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3346
Mailing Address - Country:US
Mailing Address - Phone:203-500-8339
Mailing Address - Fax:
Practice Address - Street 1:53 RIVER ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3346
Practice Address - Country:US
Practice Address - Phone:203-500-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003710Medicare ID - Type Unspecified