Provider Demographics
NPI:1043295835
Name:MANTELL, MADELINE C (MS)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:C
Last Name:MANTELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MADI
Other - Middle Name:
Other - Last Name:MANTELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:101 BANBURY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1660
Mailing Address - Country:US
Mailing Address - Phone:215-527-3537
Mailing Address - Fax:
Practice Address - Street 1:606 SPRINGHOUSE VILLAGE CENTER
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477
Practice Address - Country:US
Practice Address - Phone:215-646-3969
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional