Provider Demographics
NPI:1689059842
Name:MANZI, BETSY (LCSW 091696)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:MANZI
Suffix:
Gender:F
Credentials:LCSW 091696
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:MANZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 FIVE ROSES E
Mailing Address - Street 2:
Mailing Address - City:ANCRAM
Mailing Address - State:NY
Mailing Address - Zip Code:12502-5400
Mailing Address - Country:US
Mailing Address - Phone:845-594-4590
Mailing Address - Fax:
Practice Address - Street 1:18 FIVE ROSES E
Practice Address - Street 2:
Practice Address - City:ANCRAM
Practice Address - State:NY
Practice Address - Zip Code:12502-5400
Practice Address - Country:US
Practice Address - Phone:845-594-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0916961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1841287190Medicaid