Provider Demographics
NPI:1538781968
Name:MANZUETA, SANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MANZUETA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MARKET ST STE 376
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7619
Mailing Address - Country:US
Mailing Address - Phone:914-327-2827
Mailing Address - Fax:914-327-2844
Practice Address - Street 1:73 MARKET ST STE 376
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-7619
Practice Address - Country:US
Practice Address - Phone:914-426-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074273-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02431556Medicaid