Provider Demographics
NPI:1508416645
Name:PHILIP-NEDUMAKEL, MANJU
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:PHILIP-NEDUMAKEL
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:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:732-688-7468
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:STE 1803A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7725
Practice Address - Country:US
Practice Address - Phone:732-688-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0203561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical