Basic Information
| Provider Information | |||||||||
| NPI: | 1568593523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANBECK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 NAPA VALLEJO HWY. | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945586293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072535654 | ||||||||
| FaxNumber: | 7072535097 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 NAPA VALLEJO HWY. | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945586293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072535654 | ||||||||
| FaxNumber: | 7072535097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY22168 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 22168 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.