Provider Demographics
NPI:1700061942
Name:MAN, AGNES Y (MSW)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:Y
Last Name:MAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE ST
Mailing Address - Street 2:APT 20
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1653
Mailing Address - Country:US
Mailing Address - Phone:781-331-7866
Mailing Address - Fax:781-331-7976
Practice Address - Street 1:815 WASHINGTON ST
Practice Address - Street 2:STE 4
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1637
Practice Address - Country:US
Practice Address - Phone:781-331-7866
Practice Address - Fax:781-331-7976
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker