| Doctor Name: | MRS. KELLI ANN MANZANO |
| NPI Number: | 1003146978 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW-C, LICSW |
| License Number: | DP00944880 |
| Business Practice Address: | 750 Hospital Way Hagerstown, MD - 217422741 |
| Business Phone Number: | 2403133321 |
| Business Fax Number: | 3017901314 |
| Mailing Address: | 13114 Pennsylvania Ave, HAGERSTOWN |
| State: | MD |
| Postal Code: | 217422741 |
| Phone Number: | 2403133321 |
| Fax Number: | 3017901314 |
| NPI Enumeration Date: | 12/28/2009 |
| NPI Last Update Date: | 05/30/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | DP00944880 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |