Provider Demographics
NPI:1730666421
Name:MANCUSO, CHRISTINA MARIE (SERVICE COORDINATOR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 MONTAUK HWY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1492
Mailing Address - Country:US
Mailing Address - Phone:631-218-1545
Mailing Address - Fax:631-218-2650
Practice Address - Street 1:1227 MONTAUK HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1492
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:631-218-2650
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator