Provider Demographics
NPI:1144024753
Name:MANTASHASHVILI, AZA (CMHC)
Entity type:Individual
Prefix:DR
First Name:AZA
Middle Name:
Last Name:MANTASHASHVILI
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:DR
Other - First Name:AZA
Other - Middle Name:
Other - Last Name:MANTASHASHVILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMHC
Mailing Address - Street 1:214 E 82ND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2728
Mailing Address - Country:US
Mailing Address - Phone:914-441-7460
Mailing Address - Fax:
Practice Address - Street 1:1 STONE PL
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3426
Practice Address - Country:US
Practice Address - Phone:914-441-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health