Provider Demographics
NPI:1922511435
Name:MANNEY, KATRINA (LCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MANNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:SIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4101 S DREXEL BLVD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3328
Mailing Address - Country:US
Mailing Address - Phone:773-620-7860
Mailing Address - Fax:
Practice Address - Street 1:4101 S DREXEL BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3328
Practice Address - Country:US
Practice Address - Phone:773-620-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490191651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical