Provider Demographics
NPI:1881674240
Name:MANTZ, CARL ROBERT (LSW)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ROBERT
Last Name:MANTZ
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7113
Mailing Address - Country:US
Mailing Address - Phone:724-316-6590
Mailing Address - Fax:
Practice Address - Street 1:100 NORTHPOINTE CIR
Practice Address - Street 2:SUITE 306
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7851
Practice Address - Country:US
Practice Address - Phone:724-772-4848
Practice Address - Fax:724-772-4888
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013696L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker