Provider Demographics
NPI:1891845723
Name:MANCHESTER, MARYANN R (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:R
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3518
Mailing Address - Country:US
Mailing Address - Phone:914-478-3646
Mailing Address - Fax:
Practice Address - Street 1:256 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-3518
Practice Address - Country:US
Practice Address - Phone:914-478-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist