Provider Demographics
NPI:1811450109
Name:MCMANAMAN, MARY THERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:MCMANAMAN
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 1:1009 WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3126
Mailing Address - Country:US
Mailing Address - Phone:302-236-6824
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST STE 251
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2748
Practice Address - Country:US
Practice Address - Phone:717-388-4159
Practice Address - Fax:717-807-6133
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist