Provider Demographics
NPI:1518428655
Name:MANZANO, REBECCA K
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:MANZANO
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 1:97 SKIPPER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1611
Mailing Address - Country:US
Mailing Address - Phone:860-990-5085
Mailing Address - Fax:
Practice Address - Street 1:97 SKIPPER ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1611
Practice Address - Country:US
Practice Address - Phone:860-990-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor