Provider Demographics
NPI:1215350806
Name:MANSON, RICHARD J (BSW , CAP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MANSON
Suffix:
Gender:M
Credentials:BSW , CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7664 S FEDERAL HWY # US1
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2315
Mailing Address - Country:US
Mailing Address - Phone:772-245-0075
Mailing Address - Fax:
Practice Address - Street 1:7664 S FEDERAL HWY # US1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2315
Practice Address - Country:US
Practice Address - Phone:772-245-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5814101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)