Provider Demographics
NPI:1083822746
Name:MANDEL, DEBRA DONNENBERG (MS,ATR,SAS,SDA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DONNENBERG
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MS,ATR,SAS,SDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2209
Mailing Address - Country:US
Mailing Address - Phone:718-258-2004
Mailing Address - Fax:718-338-2075
Practice Address - Street 1:885 E 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2209
Practice Address - Country:US
Practice Address - Phone:718-258-2004
Practice Address - Fax:718-338-2075
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004013-1101YM0800X
NY118814862252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health