Provider Demographics
NPI:1942798657
Name:BASES-MANICK, DARLENE JOY (LMFT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:JOY
Last Name:BASES-MANICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:JOY
Other - Last Name:MANICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1445 W LONGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-6100
Mailing Address - Country:US
Mailing Address - Phone:818-854-2348
Mailing Address - Fax:
Practice Address - Street 1:1445 W LONGVIEW LN
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-6100
Practice Address - Country:US
Practice Address - Phone:818-854-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist