Provider Demographics
NPI:1457648529
Name:MCMANUS, TODD MARSHALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MARSHALL
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 STUART ST
Mailing Address - Street 2:APT. B
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1127
Mailing Address - Country:US
Mailing Address - Phone:510-825-5233
Mailing Address - Fax:
Practice Address - Street 1:1020 MISSOURI ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6112
Practice Address - Country:US
Practice Address - Phone:510-825-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical