Provider Demographics
NPI:1891948105
Name:MANZI, MARISSA ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:ANNE
Last Name:MANZI
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 1:1680 ALBANY AVE
Mailing Address - Street 2:THE VILLAGE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1001
Mailing Address - Country:US
Mailing Address - Phone:860-297-0573
Mailing Address - Fax:860-296-1071
Practice Address - Street 1:1680 ALBANY AVE
Practice Address - Street 2:THE VILLAGE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1001
Practice Address - Country:US
Practice Address - Phone:860-297-0573
Practice Address - Fax:860-296-1071
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical