Provider Demographics
NPI:1528383957
Name:MANTON, ELSIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:J
Last Name:MANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 CINEBAR DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6116
Mailing Address - Country:US
Mailing Address - Phone:561-826-8114
Mailing Address - Fax:
Practice Address - Street 1:7595 CINEBAR DRIVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6116
Practice Address - Country:US
Practice Address - Phone:561-504-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1924104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1041C0700XMedicare PIN