Provider Demographics
NPI:1023226867
Name:MUNOZ, MANUEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14935 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1607
Mailing Address - Country:US
Mailing Address - Phone:718-767-1151
Mailing Address - Fax:718-767-1151
Practice Address - Street 1:14935 5TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1607
Practice Address - Country:US
Practice Address - Phone:718-767-1151
Practice Address - Fax:718-767-1151
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030398-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical