Provider Demographics
NPI:1902425960
Name:MANZANARES, PATRICK JAMES (LMSW, CHES)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:MANZANARES
Suffix:
Gender:M
Credentials:LMSW, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4808
Mailing Address - Country:US
Mailing Address - Phone:505-717-1332
Mailing Address - Fax:866-837-5767
Practice Address - Street 1:4201 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4808
Practice Address - Country:US
Practice Address - Phone:505-717-1332
Practice Address - Fax:866-837-5767
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-11019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker