Provider Demographics
NPI:1669758124
Name:MANCINI-MICHELL, ANITA (PSYD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MANCINI-MICHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 S. NEW BRAUNFELS
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3002
Mailing Address - Country:US
Mailing Address - Phone:210-532-8811
Mailing Address - Fax:210-531-8172
Practice Address - Street 1:6711 S NEW BRAUNFELS AVE
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3005
Practice Address - Country:US
Practice Address - Phone:210-532-8811
Practice Address - Fax:210-531-8172
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist