Provider Demographics
NPI:1285700054
Name:MANELA, MATTHEW B (MSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
Last Name:MANELA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 OLIVER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1438
Mailing Address - Country:US
Mailing Address - Phone:508-230-2664
Mailing Address - Fax:508-223-3601
Practice Address - Street 1:18 OLIVER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1438
Practice Address - Country:US
Practice Address - Phone:508-230-2664
Practice Address - Fax:508-223-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23034Medicare ID - Type Unspecified