Provider Demographics
NPI:1760419345
Name:MANI, REBECCA M (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:MANI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOPE RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7202
Mailing Address - Country:US
Mailing Address - Phone:540-659-2725
Mailing Address - Fax:540-659-0736
Practice Address - Street 1:15 HOPE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7202
Practice Address - Country:US
Practice Address - Phone:540-659-2725
Practice Address - Fax:540-659-0736
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040043851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800002836Medicare ID - Type Unspecified