Provider Demographics
NPI:1407641517
Name:MANNARINO, SOFIA RAE (LSW)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:RAE
Last Name:MANNARINO
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 KENTUCKY WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4639
Mailing Address - Country:US
Mailing Address - Phone:732-492-5670
Mailing Address - Fax:
Practice Address - Street 1:203 CANDLEWOOD CMNS
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2169
Practice Address - Country:US
Practice Address - Phone:732-561-8555
Practice Address - Fax:732-561-1165
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL072583001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical