Provider Demographics
NPI:1700364239
Name:MANZI, DONNA (LCSW-R, PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:MANZI
Suffix:
Gender:F
Credentials:LCSW-R, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2751
Mailing Address - Country:US
Mailing Address - Phone:631-265-0007
Mailing Address - Fax:
Practice Address - Street 1:35 MANOR RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2751
Practice Address - Country:US
Practice Address - Phone:631-265-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWR0791941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical