Basic Information
| Provider Information | |||||||||
| NPI: | 1336279207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANCZAREK | ||||||||
| FirstName: | TANIA | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 W. MAPLE AVE. | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242005424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10929 SOUTH ST | ||||||||
| Address2: | 208B | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907035340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629245526 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 22075 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.