Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 68P08737 | NY |
Y | 103TC0700X | Clinical Psychologist | 68P08737 | NY |
NPI | 1003309790 |
---|---|
Provider Name | Adam Dean Mandel |
First Address | New York, NY 10023-6221 |
Second Address | New York, NY 10023-7603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |