Provider Demographics
NPI:1396218913
Name:MANUCHARYAN, ELENA ANNIE (LCSW #115661)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:ANNIE
Last Name:MANUCHARYAN
Suffix:
Gender:F
Credentials:LCSW #115661
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 E QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2354
Mailing Address - Country:US
Mailing Address - Phone:559-269-0416
Mailing Address - Fax:
Practice Address - Street 1:5610 W DONNER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3721
Practice Address - Country:US
Practice Address - Phone:559-352-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA1156611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical