Provider Demographics
NPI:1518491901
Name:MCMANNESS, KAREN (BCBA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MCMANNESS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 PENLLYN BLUE BELL PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2109
Mailing Address - Country:US
Mailing Address - Phone:215-833-3171
Mailing Address - Fax:
Practice Address - Street 1:1399 PENLLYN BLUE BELL PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2109
Practice Address - Country:US
Practice Address - Phone:215-833-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst