Provider Demographics
NPI:1023105475
Name:MANKOWSKI, MARIANN (MSW, PHD)
Entity type:Individual
Prefix:MS
First Name:MARIANN
Middle Name:
Last Name:MANKOWSKI
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:DR
Other - First Name:MARIANN
Other - Middle Name:
Other - Last Name:MANKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11 TOWN LINE DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-6102
Mailing Address - Country:US
Mailing Address - Phone:134-687-8489
Mailing Address - Fax:
Practice Address - Street 1:11 TOWN LINE DR
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424
Practice Address - Country:US
Practice Address - Phone:134-687-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical