Provider Demographics
NPI:1689551020
Name:MANZI, MEGAN (LAC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:MANZI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2403
Mailing Address - Country:US
Mailing Address - Phone:310-259-7218
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMIT AVE STE A10
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1526
Practice Address - Country:US
Practice Address - Phone:201-468-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00886000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health