Basic Information
| Provider Information | |||||||||
| NPI: | 1104115252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANION | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5676 RIVERDALE AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104712138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187965300 | ||||||||
| FaxNumber: | 7185481161 | ||||||||
| Practice Location | |||||||||
| Address1: | 5676 RIVERDALE AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104712138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187965300 | ||||||||
| FaxNumber: | 7185481161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2011 | ||||||||
| LastUpdateDate: | 03/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.