Provider Demographics
NPI:1174624050
Name:COMENDANT, MANON (LCSW)
Entity type:Individual
Prefix:MS
First Name:MANON
Middle Name:
Last Name:COMENDANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 SMOKETREE COMMONS
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7961
Mailing Address - Country:US
Mailing Address - Phone:925-872-5843
Mailing Address - Fax:
Practice Address - Street 1:7080 DONLON WAY
Practice Address - Street 2:SUITE 118
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2787
Practice Address - Country:US
Practice Address - Phone:925-872-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS222611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2160822OtherCOMPSYCH
CALCS222610OtherBLUE SHIELD OF CALIFORNIA
CA1330487OtherCOMPSYCH
CACSW222610Medicaid
KY417285OtherMENTAL HEALTH NETWORK
CALCS222610OtherBLUE SHIELD OF CALIFORNIA