Provider Demographics
NPI:1851461875
Name:MANOLEAS, PETER GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:GEORGE
Last Name:MANOLEAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3356 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2737
Mailing Address - Country:US
Mailing Address - Phone:510-525-2519
Mailing Address - Fax:510-525-2519
Practice Address - Street 1:3356 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2737
Practice Address - Country:US
Practice Address - Phone:510-525-2519
Practice Address - Fax:510-525-2519
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS-6903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW0690Medicaid