Provider Demographics
NPI:1134346562
Name:MANZO, PETER A (MSW, LICSW,CEAP)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:MANZO
Suffix:
Gender:M
Credentials:MSW, LICSW,CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TALL OAKS DRIVE
Mailing Address - Street 2:UNIT 301
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-3508
Mailing Address - Country:US
Mailing Address - Phone:781-337-5066
Mailing Address - Fax:
Practice Address - Street 1:10 TREMONT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2008
Practice Address - Country:US
Practice Address - Phone:617-797-1559
Practice Address - Fax:617-574-9607
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical