Provider Demographics
NPI:1144246695
Name:MANDEL, FRIEDA T (LCSW)
Entity Type:Individual
Prefix:
First Name:FRIEDA
Middle Name:T
Last Name:MANDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3206
Mailing Address - Country:US
Mailing Address - Phone:516-481-1603
Mailing Address - Fax:
Practice Address - Street 1:292 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3206
Practice Address - Country:US
Practice Address - Phone:516-481-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN72361Medicare ID - Type Unspecified