Provider Demographics
NPI:1376721670
Name:MANUCIA, GLORIA KATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:KATHERINE
Last Name:MANUCIA
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 1:1529 RIVER OAKS RD W
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2162
Mailing Address - Country:US
Mailing Address - Phone:504-648-1220
Mailing Address - Fax:504-455-9625
Practice Address - Street 1:4601 JAMES DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-1213
Practice Address - Country:US
Practice Address - Phone:504-455-9625
Practice Address - Fax:504-455-9625
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA622103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S665Medicare PIN