Provider Demographics
NPI:1548464589
Name:MANELA, THERESA LYNN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN
Last Name:MANELA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 N WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1013
Mailing Address - Country:US
Mailing Address - Phone:508-223-3601
Mailing Address - Fax:508-223-2323
Practice Address - Street 1:41 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2315
Practice Address - Country:US
Practice Address - Phone:508-946-2040
Practice Address - Fax:508-946-2029
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1548464589OtherSCHOOL