Provider Demographics
NPI:1427531227
Name:MANAVIZADEH, NADER DANIEL
Entity type:Individual
Prefix:
First Name:NADER
Middle Name:DANIEL
Last Name:MANAVIZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 CORPORATE CT
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-3157
Mailing Address - Country:US
Mailing Address - Phone:610-769-4111
Mailing Address - Fax:610-769-1154
Practice Address - Street 1:2936 CORPORATE CT
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-3157
Practice Address - Country:US
Practice Address - Phone:610-769-4111
Practice Address - Fax:610-769-1154
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor