Provider Demographics
NPI:1831793280
Name:MANINGAS, MAXIM RAYMUNDO (ACSW)
Entity type:Individual
Prefix:MR
First Name:MAXIM
Middle Name:RAYMUNDO
Last Name:MANINGAS
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:MR
Other - First Name:MAXIM
Other - Middle Name:RAYMUNDO
Other - Last Name:MANINGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACSW
Mailing Address - Street 1:3853 ROSECRANS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8257
Mailing Address - Fax:619-542-4060
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8257
Practice Address - Fax:619-542-4060
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW968851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW96885Medicaid