Provider Demographics
NPI:1871829804
Name:MCMANUS, EDDA H (LCSW)
Entity Type:Individual
Prefix:
First Name:EDDA
Middle Name:H
Last Name:MCMANUS
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 1:567 VAUXHALL STREET EXT
Mailing Address - Street 2:STE 314
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4330
Mailing Address - Country:US
Mailing Address - Phone:860-334-9063
Mailing Address - Fax:860-381-5099
Practice Address - Street 1:567 VAUXHALL STREET EXT
Practice Address - Street 2:STE 314
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4330
Practice Address - Country:US
Practice Address - Phone:860-334-9063
Practice Address - Fax:860-381-5099
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0071691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical