Provider Demographics
NPI:1366908352
Name:DEOLALKAR, MANALI
Entity type:Individual
Prefix:
First Name:MANALI
Middle Name:
Last Name:DEOLALKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 104TH ST APT 56
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4261
Mailing Address - Country:US
Mailing Address - Phone:718-708-2759
Mailing Address - Fax:
Practice Address - Street 1:115 W 104TH ST APT 56
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4261
Practice Address - Country:US
Practice Address - Phone:718-708-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health