Provider Demographics
NPI:1699664219
Name:ANDRES, MANUELA
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:ANDRES
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 1:553 MANTON AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5034
Mailing Address - Country:US
Mailing Address - Phone:401-632-5853
Mailing Address - Fax:
Practice Address - Street 1:1000 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1507
Practice Address - Country:US
Practice Address - Phone:401-722-0081
Practice Address - Fax:401-312-0318
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW041281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical