Provider Demographics
NPI:1063601557
Name:MANLEY, DEBORAH J (MSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:MANLEY
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 1:520 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7444
Mailing Address - Country:US
Mailing Address - Phone:732-557-4422
Mailing Address - Fax:732-557-4422
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7444
Practice Address - Country:US
Practice Address - Phone:732-557-4422
Practice Address - Fax:732-557-4422
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043122001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ904267Medicare PIN