Provider Demographics
NPI:1720856891
Name:MANKARIOUS, MIRAY
Entity Type:Individual
Prefix:
First Name:MIRAY
Middle Name:
Last Name:MANKARIOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PAMRAPO CT APT 3B
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2147
Mailing Address - Country:US
Mailing Address - Phone:201-492-0555
Mailing Address - Fax:
Practice Address - Street 1:6 PAMRAPO CT APT 3B
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2147
Practice Address - Country:US
Practice Address - Phone:201-492-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
44SC062926001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical