Active NPI
Brea Ann Manetta, PH.D.
- Psychologist
- Fort Collins, CO
National Provider Identifier
1932243011
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jul 18, 2013.
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2568
- Practice address
- 19 Old Town SQ
Fort Collins, CO 80524-2471 - Phone
- (970) 391-0629
- Fax
- (970) 482-0251
- NPI assigned
- Feb 20, 2007
- Last updated
- Oct 23, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2568 | CO | Primary |
Addresses
Primary practice location
19 Old Town SQ
Fort Collins, CO 80524-2471
Mailing address
19 Old Town SQ
Fort Collins, CO 80524-2471
Phone (970) 391-0629
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01707353 | Medicaid | CO | |
| 018336 | Other | CO | VALUE OPTIONS |
| 2270399 | Other | CO | CIGNA |
| 7079467 | Other | CO | AETNA |
| MA658563 | Other | CO | BLUE CROSS |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2568 | CO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224720000000",
"number": "1932243011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 OLD TOWN SQ",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242471",
"telephone_number": "970-391-0629",
"fax_number": "970-482-0251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 OLD TOWN SQ",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242471",
"telephone_number": "970-391-0629",
"fax_number": "970-482-0251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANETTA",
"first_name": "BREA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2008-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "2568",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01707353",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "018336",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2270399",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7079467",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "MA658563",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.