Provider Demographics
NPI:1184763138
Name:MANNING, LAURA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:MANNING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SOQUEL DR STE 650
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2862
Mailing Address - Country:US
Mailing Address - Phone:831-421-2767
Mailing Address - Fax:831-476-6360
Practice Address - Street 1:5905 SOQUEL DR STE 650
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2862
Practice Address - Country:US
Practice Address - Phone:831-421-2767
Practice Address - Fax:831-476-6360
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 113601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70022Medicare UPIN
ZZZ24378ZMedicare ID - Type Unspecified