Provider Demographics
NPI:1912520586
Name:PATEL, MANISHA S (MSW)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:S
Last Name:PATEL
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 1:173 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3449
Mailing Address - Country:US
Mailing Address - Phone:734-377-6738
Mailing Address - Fax:
Practice Address - Street 1:204 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2070
Practice Address - Country:US
Practice Address - Phone:734-478-7358
Practice Address - Fax:734-585-5634
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health