Provider Demographics
NPI:1467951988
Name:MANNARINO, JULIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MANNARINO
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 1:3250 W LAKE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3691
Mailing Address - Country:US
Mailing Address - Phone:814-790-4567
Mailing Address - Fax:814-295-4074
Practice Address - Street 1:3250 W LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3691
Practice Address - Country:US
Practice Address - Phone:814-790-4567
Practice Address - Fax:814-295-4074
Is Sole Proprietor?:No
Enumeration Date:2018-02-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0197291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW019729OtherSTATE BOARD OF SOCIAL WORKERS OF PENNSYLVANIA