Provider Demographics
NPI:1386781581
Name:MANSON, MICHAEL FRANCIS (MSSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MANSON
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W MAIN ST
Mailing Address - Street 2:VA CBOC
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5128
Mailing Address - Country:US
Mailing Address - Phone:352-435-4006
Mailing Address - Fax:352-435-4016
Practice Address - Street 1:711 W MAIN ST
Practice Address - Street 2:VA CBOC
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5128
Practice Address - Country:US
Practice Address - Phone:352-435-4006
Practice Address - Fax:352-435-4016
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical