Provider Demographics
NPI:1609145382
Name:MANNEN, MARY ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:MANNEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CROWN OAK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6166
Mailing Address - Country:US
Mailing Address - Phone:407-376-3773
Mailing Address - Fax:
Practice Address - Street 1:100 CROWN OAK CENTRE DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6166
Practice Address - Country:US
Practice Address - Phone:407-376-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health