Provider Demographics
NPI:1184823080
Name:MANDLER, REBECCA DORISON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DORISON
Last Name:MANDLER
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 1:7600 RED RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5428
Mailing Address - Country:US
Mailing Address - Phone:305-254-2791
Mailing Address - Fax:305-254-2791
Practice Address - Street 1:7600 RED RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5428
Practice Address - Country:US
Practice Address - Phone:305-254-2791
Practice Address - Fax:305-254-2791
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9146YMedicare PIN