Provider Demographics
NPI:1629322763
Name:MANNING, ROXANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SACRAMENTO ST
Mailing Address - Street 2:APT 3
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1235
Mailing Address - Country:US
Mailing Address - Phone:408-420-3933
Mailing Address - Fax:
Practice Address - Street 1:1325 SACRAMENTO ST
Practice Address - Street 2:APT 3
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1235
Practice Address - Country:US
Practice Address - Phone:408-420-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24478103TC0700X
NC2982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical