Provider Demographics
NPI:1689245045
Name:MANNO, CARINA
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:MANNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CRESCENT DR APT 58
Mailing Address - Street 2:
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-1646
Mailing Address - Country:US
Mailing Address - Phone:845-274-1571
Mailing Address - Fax:
Practice Address - Street 1:155 PHILLIPS HILL RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4129
Practice Address - Country:US
Practice Address - Phone:845-641-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009815-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant