Provider Demographics
NPI:1114757457
Name:MANIERSKI, MEGAN E (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:MANIERSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W TROY ST STE B
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4455
Mailing Address - Country:US
Mailing Address - Phone:334-758-6603
Mailing Address - Fax:
Practice Address - Street 1:212 W TROY ST STE B
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4455
Practice Address - Country:US
Practice Address - Phone:334-758-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist