Provider Demographics
NPI:1760550115
Name:MANZELLA, MARGARET FRANCES (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:FRANCES
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 BIDWELL PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1164
Mailing Address - Country:US
Mailing Address - Phone:716-883-0877
Mailing Address - Fax:716-886-0016
Practice Address - Street 1:142 BIDWELL PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1164
Practice Address - Country:US
Practice Address - Phone:716-883-0877
Practice Address - Fax:716-886-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO212891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085361Medicare ID - Type Unspecified