Provider Demographics
NPI:1194071100
Name:MANNING, NATASHA NICKOLE (PHD, LPC)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:NICKOLE
Last Name:MANNING
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MILLBURN AVE
Mailing Address - Street 2:SUITE D1
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040
Mailing Address - Country:US
Mailing Address - Phone:973-536-7486
Mailing Address - Fax:973-763-8243
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:SUITE D1
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:973-536-7486
Practice Address - Fax:973-763-8243
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00457000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional