Provider Demographics
NPI:1093899544
Name:MANDELBAUM, DEBORAH ARMOUR (MSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ARMOUR
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2009
Mailing Address - Country:US
Mailing Address - Phone:973-378-3269
Mailing Address - Fax:973-378-3627
Practice Address - Street 1:124 E 84TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0915
Practice Address - Country:US
Practice Address - Phone:212-969-8659
Practice Address - Fax:973-378-3627
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032769-11041C0700X
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N92641Medicare ID - Type Unspecified