Ebony Lauren Manzano, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P020429 Issued in NC

Practice address

9541 Julian Clark Ave Ste 208
Huntersville, NC 28078-3486

Phone

(704) 796-9037

NPI assigned

Apr 17, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1073368783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088650053",
            "telephone_number": "201-772-8417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9541 JULIAN CLARK AVE STE 208",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280783486",
            "telephone_number": "704-796-9037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZANO",
        "first_name": "EBONY",
        "middle_name": "LAUREN",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06985900",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NJ",
            "license": "01739993",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P020429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd Malloy, MA, LMFT, CST, CSE
• James Bryant Mammel, MD
• Inderjit Mander
• Jennifer Tara Manley, RD LDN
• Jennifer Ann Mannisto
• Marc E Allen Ms I PLLC (Care Source Mobile)
• Lauri Ann Mares, AGPCNP
• Melissa Marin, PSY.D.
• Mark D. Peacock MD PC
• Emily Rebecca Markey, PA-C

• Clinical Social Worker in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.