Provider Demographics
NPI:1477581502
Name:MANFREDI, CHERYL M (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:MANFREDI
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 1:1148 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6426
Mailing Address - Country:US
Mailing Address - Phone:201-224-9596
Mailing Address - Fax:201-224-9596
Practice Address - Street 1:140 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6421
Practice Address - Country:US
Practice Address - Phone:201-224-9596
Practice Address - Fax:201-224-9596
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSL056273R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11566961OtherCAQH CREDENTIALING