Provider Demographics
NPI:1912232398
Name:MANCUSO, ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:MANCUSO
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 1:15 NUTMEG CT
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7022
Mailing Address - Country:US
Mailing Address - Phone:732-233-8826
Mailing Address - Fax:
Practice Address - Street 1:331 NEWMAN SPRINGS RD
Practice Address - Street 2:BUILDING 1, 4TH FLOOR, SUITE 143
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5688
Practice Address - Country:US
Practice Address - Phone:732-233-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00317600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional