Provider Demographics
NPI:1245609635
Name:MANISCO CHAPO, SARA MARINA (LICSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARINA
Last Name:MANISCO CHAPO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SARA MARINA
Other - Middle Name:
Other - Last Name:CHAPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 3041
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-3077
Mailing Address - Country:US
Mailing Address - Phone:512-710-0551
Mailing Address - Fax:512-717-6337
Practice Address - Street 1:5524 BEE CAVES RD STE H2
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5246
Practice Address - Country:US
Practice Address - Phone:512-710-0551
Practice Address - Fax:512-717-6337
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22181041C0700X
TX678491041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX440469101Medicaid