Provider Demographics
NPI:1730814690
Name:MANIATAKOS, ELIANNA
Entity type:Individual
Prefix:
First Name:ELIANNA
Middle Name:
Last Name:MANIATAKOS
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 1:259 NORRIDGEWOCK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3179
Mailing Address - Country:US
Mailing Address - Phone:207-692-3586
Mailing Address - Fax:
Practice Address - Street 1:62 PEGASUS ST STE 200
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-5028
Practice Address - Country:US
Practice Address - Phone:207-798-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker