NPIMap

Individual provider Active NPI

Peter George Manoleas, LCSW

  • Mental Health Counselor
  • Berkeley, CA
National Provider Identifier
1851461875
Registry record updated Oct 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LCS-6903 Issued in CA
Practice address
3356 Adeline St
Berkeley, CA 94703-2737
Phone
(510) 525-2519
Fax
(510) 525-2519
NPI assigned
Nov 8, 2006
Last updated
Oct 8, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LCS-6903 CA Primary

Addresses

Primary practice location

3356 Adeline St
Berkeley, CA 94703-2737

Mailing address

3356 Adeline St
Berkeley, CA 94703-2737
Phone (510) 525-2519

Other identifiers 1

IdentifierTypeStateIssuer
CSW0690MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121023000216 CA Practitioner - Clinical Social Worker 0244215143 Practice locations: Berkeley, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS-6903CAMDMental Health Counselor

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
La Clinica Pittsburg - MedicalPittsburg, CA, CCN 551976 Federally qualified health center Corporate Director Jul 8, 2004
San Antonio Neighborhood Health CenterOakland, CA, CCN 051822 Federally qualified health center Corporate Director Jul 27, 2004
La Clinica MonumentConcord, CA, CCN 051062 Federally qualified health center Corporate Director Feb 21, 2012
Family Optical IOakland, CA, CCN 051066 Federally qualified health center Corporate Director Nov 3, 2006
La Clinica de la RazaOakland, CA, CCN 551975 Federally qualified health center Corporate Director Feb 8, 2007
Clinica Alta VistaOakland, CA, CCN 051821 Federally qualified health center Corporate Director Feb 20, 2007

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444262400000",
    "number": "1851461875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3356 ADELINE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032737",
            "telephone_number": "510-525-2519",
            "fax_number": "510-525-2519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3356 ADELINE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032737",
            "telephone_number": "510-525-2519",
            "fax_number": "510-525-2519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANOLEAS",
        "first_name": "PETER",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2015-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LCS-6903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CSW0690",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.