Provider Demographics
NPI:1982215760
Name:MANTZEY, ALESSANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:
Last Name:MANTZEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALESSANDRA
Other - Middle Name:
Other - Last Name:AGOSTINELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15919 COLTON WL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5930
Mailing Address - Country:US
Mailing Address - Phone:407-310-4368
Mailing Address - Fax:
Practice Address - Street 1:15919 COLTON WL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5930
Practice Address - Country:US
Practice Address - Phone:407-310-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4238177171M00000X
TX567451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty