Provider Demographics
NPI:1083958730
Name:MANDELL, HARRIET (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:
Last Name:MANDELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S PACA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1771
Mailing Address - Country:US
Mailing Address - Phone:410-328-5719
Mailing Address - Fax:410-328-2555
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-5719
Practice Address - Fax:410-328-2555
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04627261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care