Provider Demographics
NPI:1912221698
Name:MANTSCH, SANDRA DIANA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DIANA
Last Name:MANTSCH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 W 8TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4759
Practice Address - Country:US
Practice Address - Phone:814-218-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker