Provider Demographics
NPI:1386329241
Name:MANETTA, DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MANETTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S SENDERO DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1604
Mailing Address - Country:US
Mailing Address - Phone:903-573-3469
Mailing Address - Fax:
Practice Address - Street 1:210 S SENDERO DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1604
Practice Address - Country:US
Practice Address - Phone:903-573-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical