Provider Demographics
NPI:1356949820
Name:MANNO-MITCHELL, GINA (MS)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MANNO-MITCHELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4129
Mailing Address - Country:US
Mailing Address - Phone:215-805-0833
Mailing Address - Fax:
Practice Address - Street 1:800 CLARMONT AVE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5705
Practice Address - Country:US
Practice Address - Phone:267-525-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional