Provider Demographics
NPI:1568470771
Name:MANASSE, JEFFRY IRWIN (PSYD)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:IRWIN
Last Name:MANASSE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S WASHINGTON ST
Mailing Address - Street 2:#200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-305-0075
Mailing Address - Fax:630-305-3660
Practice Address - Street 1:608 S WASHINGTON ST
Practice Address - Street 2:JEFFRY MANASSE & ASSOC PC #200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-305-0075
Practice Address - Fax:630-305-3660
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0713352103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200121Medicare ID - Type Unspecified