Provider Demographics
NPI:1679762447
Name:MANIGAT, PHERNEL
Entity type:Individual
Prefix:
First Name:PHERNEL
Middle Name:
Last Name:MANIGAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SAWTELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1654
Mailing Address - Country:US
Mailing Address - Phone:617-694-7172
Mailing Address - Fax:
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4042
Practice Address - Country:US
Practice Address - Phone:508-559-6699
Practice Address - Fax:508-587-4224
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker