Provider Demographics
NPI:1164847380
Name:MANDEL, CHERYL (BCBA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 IRVING AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4544
Mailing Address - Country:US
Mailing Address - Phone:347-585-7859
Mailing Address - Fax:
Practice Address - Street 1:127 IRVING AVE APT 3
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4544
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-36877103K00000X
NY174400000X
RILBA00185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist