Provider Demographics
NPI:1639394927
Name:MANLY, JODY TODD (PHD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:TODD
Last Name:MANLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2415
Mailing Address - Country:US
Mailing Address - Phone:585-275-2991
Mailing Address - Fax:585-454-2972
Practice Address - Street 1:187 EDINBURGH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2415
Practice Address - Country:US
Practice Address - Phone:585-275-2991
Practice Address - Fax:585-454-2972
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010777-0103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical