Provider Demographics
NPI:1891229373
Name:MANCUSO, MARIA L
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:MANCUSO
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 1:180 WEST ST
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-2116
Mailing Address - Country:US
Mailing Address - Phone:732-395-9395
Mailing Address - Fax:
Practice Address - Street 1:180 WEST ST
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-2116
Practice Address - Country:US
Practice Address - Phone:732-395-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker