Provider Demographics
NPI:1154849271
Name:MANDEL, SARAH CHARLOTTE (MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CHARLOTTE
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 CHURCH ST APT 4016
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8903
Mailing Address - Country:US
Mailing Address - Phone:310-951-7059
Mailing Address - Fax:
Practice Address - Street 1:1905 BUSINESS CENTER DR UNIT 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3460
Practice Address - Country:US
Practice Address - Phone:909-289-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst