Provider Demographics
NPI:1831476704
Name:MANNING, MICHAEL KEITH JR (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEITH
Last Name:MANNING
Suffix:JR
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1111 ELM ST SUITE 7
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-231-2688
Mailing Address - Fax:
Practice Address - Street 1:1111 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1782
Practice Address - Country:US
Practice Address - Phone:413-734-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst