Provider Demographics
NPI:1154514065
Name:MCMANUS, KATIE LOIS (MSW, PPSC, LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LOIS
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:MSW, PPSC, LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LOIS
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, PPSC, LCSW
Mailing Address - Street 1:915 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3142
Mailing Address - Country:US
Mailing Address - Phone:510-879-4619
Mailing Address - Fax:
Practice Address - Street 1:915 54TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-3142
Practice Address - Country:US
Practice Address - Phone:253-227-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA439006H1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool