Provider Demographics
NPI:1679567010
Name:MANICKI, JANET G (LCSWR)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:G
Last Name:MANICKI
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-0088
Mailing Address - Country:US
Mailing Address - Phone:716-633-2120
Mailing Address - Fax:716-633-2120
Practice Address - Street 1:8899 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7628
Practice Address - Country:US
Practice Address - Phone:716-633-2120
Practice Address - Fax:716-633-2120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025226101OtherUNIVERA
NY000525610001OtherBCBS OF WNY