Provider Demographics
NPI:1376950436
Name:ST JEAN, MANUELA PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:PATRICIA
Last Name:ST JEAN
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 1:1501 MUTUAL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15204-2211
Mailing Address - Country:US
Mailing Address - Phone:203-273-6021
Mailing Address - Fax:
Practice Address - Street 1:1501 MUTUAL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15204-2211
Practice Address - Country:US
Practice Address - Phone:203-273-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008654101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor