Provider Demographics
NPI:1942523170
Name:MANZANO, JOEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:MANZANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 VEREDA DE LAS AMAPOLAS
Mailing Address - Street 2:URB VEREDAS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9692
Mailing Address - Country:US
Mailing Address - Phone:787-397-9031
Mailing Address - Fax:
Practice Address - Street 1:483 VEREDA DE LAS AMAPOLAS
Practice Address - Street 2:URB VEREDAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9692
Practice Address - Country:US
Practice Address - Phone:787-397-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical