Provider Demographics
NPI:1508086505
Name:MANSKY, TINA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MANSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 LAUREL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4243
Mailing Address - Country:US
Mailing Address - Phone:631-543-4288
Mailing Address - Fax:631-543-4288
Practice Address - Street 1:269 F EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-543-1063
Practice Address - Fax:631-543-4288
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03398611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6276549OtherUNITED BEHAVIORAL HEALTH
NY7400592OtherGHI
NY4462481OtherAETNA BEHAVIORAL HEALTH
NY1000046079OtherBEACON HEALTH AFFINITY
NYP2813431OtherOXFORD HEALTH PLANS
NY145461OtherVALUE OPTIONS
NYN9231OtherEMPIRE BLUECROSS BLUESHIE