Provider Demographics
NPI:1558196824
Name:MANA PSYCHIATRY LLC
Entity type:Organization
Organization Name:MANA PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP FNP
Authorized Official - Prefix:DR
Authorized Official - First Name:REY JERICOH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALESE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:623-313-6573
Mailing Address - Street 1:9627 W POTTER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5157
Mailing Address - Country:US
Mailing Address - Phone:623-313-6573
Mailing Address - Fax:
Practice Address - Street 1:18001 N 79TH AVE STE C61
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6038
Practice Address - Country:US
Practice Address - Phone:623-224-2403
Practice Address - Fax:623-267-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty