Provider Demographics
NPI:1649525718
Name:MANNSUR, NUAZHA AZIZAH (MSW, CAP)
Entity type:Individual
Prefix:MS
First Name:NUAZHA
Middle Name:AZIZAH
Last Name:MANNSUR
Suffix:
Gender:F
Credentials:MSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 KENT K
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-1721
Mailing Address - Country:US
Mailing Address - Phone:561-843-8850
Mailing Address - Fax:
Practice Address - Street 1:1870 FOREST HILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6061
Practice Address - Country:US
Practice Address - Phone:561-904-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2086101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker