Provider Demographics
NPI:1598902793
Name:MANUS, SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:MANUS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5299 COLLEGE AVE
Mailing Address - Street 2:ROOM #3.
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2808
Mailing Address - Country:US
Mailing Address - Phone:510-919-1521
Mailing Address - Fax:
Practice Address - Street 1:5299 COLLEGE AVE
Practice Address - Street 2:ROOM #3.
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-2808
Practice Address - Country:US
Practice Address - Phone:510-919-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 230121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 23012OtherLICENSED CLINICAL SOCIAL WORKER