Provider Demographics
NPI:1588750285
Name:MANIN, AMY
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MANIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39803 PASEO PADRE PKWY
Mailing Address - Street 2:FREMONT
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2992
Mailing Address - Country:US
Mailing Address - Phone:510-656-0595
Mailing Address - Fax:
Practice Address - Street 1:39803 PASEO PADRE PKWY
Practice Address - Street 2:FREMONT
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2992
Practice Address - Country:US
Practice Address - Phone:510-656-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS177381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTH000Medicare UPIN