Provider Demographics
NPI:1417575861
Name:MANOU, MARIANA ELENI (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:ELENI
Last Name:MANOU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 CHENANGO ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1653
Mailing Address - Country:US
Mailing Address - Phone:607-772-6904
Mailing Address - Fax:607-723-2617
Practice Address - Street 1:1182 CHENANGO ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1653
Practice Address - Country:US
Practice Address - Phone:607-772-6904
Practice Address - Fax:607-723-2617
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997780Medicaid