Active NPI
Alba Manjarres, LMSW
- Clinical Social Worker
- Pontiac, MI
National Provider Identifier
1629115563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801063848
- Practice address
- 114 Orchard Lake Rd
Pontiac, MI 48341-2244 - Phone
- (248) 858-7766
- Fax
- (248) 858-7201
- NPI assigned
- Jan 31, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801063848 | MI | Primary |
Addresses
Primary practice location
114 Orchard Lake Rd
Pontiac, MI 48341-2244
Mailing address
114 Orchard Lake Rd
Pontiac, MI 48341-2244
Phone (248) 858-7766
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1883825 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801063848 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| G & H Enterprises, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629115563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 ORCHARD LAKE RD",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483412244",
"telephone_number": "248-858-7766",
"fax_number": "248-858-7201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 ORCHARD LAKE RD",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483412244",
"telephone_number": "248-858-7766",
"fax_number": "248-858-7201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANJARRES",
"first_name": "ALBA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801063848",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1883825",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.