| Marisa Mansfield, Plc | |
|
1926 W 4th St Davenport IA 52802-1628 | |
| (563) 362-2815 | |
| Not Available |
| Full Name | Marisa Mansfield, Plc |
|---|---|
| Speciality | Social Worker |
| Location | 1926 W 4th St, Davenport, Iowa |
| Authorized Official Name and Position | Marisa Mansfield (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5633622815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marisa Mansfield, Plc 1037 Meadowview Ln Davenport IA 52806-2807 Ph: (563) 676-8521 | Marisa Mansfield, Plc 1926 W 4th St Davenport IA 52802-1628 Ph: (563) 362-2815 |
| NPI Number | 1902487739 |
|---|---|
| Provider Enumeration Date | 04/14/2021 |
| Last Update Date | 04/14/2021 |
| Certification Date | 04/14/2021 |
| Medicare PECOS PAC ID | 4789092727 |
|---|---|
| Medicare Enrollment ID | O20210413000524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902487739 | NPI | - | NPPES |
| 082627 | Other | IA | CLINICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Marisa Mansfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891202370 PECOS PAC ID: 5698184711 Enrollment ID: I20210430002426 |
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