Provider Demographics
NPI:1871840751
Name:MANSELLA, JAMES STEFAN (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEFAN
Last Name:MANSELLA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:DORIAN
Other - Middle Name:STEFAN
Other - Last Name:MANSELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8 ALTON CT
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1401
Mailing Address - Country:US
Mailing Address - Phone:516-850-5165
Mailing Address - Fax:
Practice Address - Street 1:8 ALTON CT
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1401
Practice Address - Country:US
Practice Address - Phone:516-850-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0838701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical