Provider Demographics
NPI:1558994111
Name:MANCHAND, LETRELL L
Entity Type:Individual
Prefix:
First Name:LETRELL
Middle Name:L
Last Name:MANCHAND
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 1:2065 SAINT RAYMOND AVE APT 2G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7177
Mailing Address - Country:US
Mailing Address - Phone:917-520-9303
Mailing Address - Fax:
Practice Address - Street 1:2065 SAINT RAYMOND AVE APT 2G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7177
Practice Address - Country:US
Practice Address - Phone:917-520-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health