Provider Demographics
NPI:1386153294
Name:MANSO, BARBARA MELISSA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MELISSA
Last Name:MANSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12742 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2251
Mailing Address - Country:US
Mailing Address - Phone:786-715-8679
Mailing Address - Fax:
Practice Address - Street 1:1801 CORAL WAY STE 327
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2784
Practice Address - Country:US
Practice Address - Phone:786-543-1865
Practice Address - Fax:786-543-1865
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst