Provider Demographics
NPI:1003997263
Name:MANLOVE, NATHAN ANDREW (LICSW)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ANDREW
Last Name:MANLOVE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MOUNTAIN WELLNESS ASSOCIATES
Mailing Address - Street 2:163 WASHINGTON STREET
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3131
Mailing Address - Country:US
Mailing Address - Phone:603-283-0195
Mailing Address - Fax:603-283-0197
Practice Address - Street 1:MOUNTAIN WELLNESS ASSOCIATES
Practice Address - Street 2:163 WASHINGTON STREET
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3131
Practice Address - Country:US
Practice Address - Phone:603-283-0195
Practice Address - Fax:603-283-0197
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078508Medicaid
NH81263595Medicaid