Provider Demographics
NPI:1477904977
Name:MANZO, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 LEDGEMONT LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5379
Mailing Address - Country:US
Mailing Address - Phone:407-416-4602
Mailing Address - Fax:
Practice Address - Street 1:506 S HIGHWAY 27
Practice Address - Street 2:SUITE N
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-2700
Practice Address - Country:US
Practice Address - Phone:352-348-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health