Provider Demographics
NPI:1699211755
Name:MANESS, KEVIN (LSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MANESS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4010
Mailing Address - Country:US
Mailing Address - Phone:215-638-5200
Mailing Address - Fax:
Practice Address - Street 1:4833 HULMEVILLE RD.
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-638-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1340661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical