Provider Demographics
NPI:1467766147
Name:MANUSE, PATRICIA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:MANUSE
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 1:794 BUTTON AVE
Mailing Address - Street 2:APT. 31
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-9509
Mailing Address - Country:US
Mailing Address - Phone:209-337-5401
Mailing Address - Fax:
Practice Address - Street 1:309 CHERRY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4312
Practice Address - Country:US
Practice Address - Phone:209-337-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
CALCS 231241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral