Provider Demographics
NPI:1003699919
Name:MANDEL, ANDREA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:MANDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:ELIZABETH
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6057 N TALMAN AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4037
Mailing Address - Country:US
Mailing Address - Phone:224-623-1602
Mailing Address - Fax:
Practice Address - Street 1:6057 N TALMAN AVE APT 2B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4037
Practice Address - Country:US
Practice Address - Phone:224-623-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist