Provider Demographics
NPI:1447313366
Name:MANCHESTER, SEAN (LICSW)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MANCHESTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TRINITY PKWY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1932
Mailing Address - Country:US
Mailing Address - Phone:401-331-9125
Mailing Address - Fax:
Practice Address - Street 1:19 TRINITY PKWY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1932
Practice Address - Country:US
Practice Address - Phone:401-331-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW010631041C0700X
MA1080551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical