Provider Demographics
NPI:1275916579
Name:DAVID MANDELBAUM, PH.D.
Entity Type:Organization
Organization Name:DAVID MANDELBAUM, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:MANDELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-429-0195
Mailing Address - Street 1:1301 N HARRISON ST
Mailing Address - Street 2:101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3128
Mailing Address - Country:US
Mailing Address - Phone:302-429-0195
Mailing Address - Fax:302-777-1712
Practice Address - Street 1:1301 N HARRISON ST
Practice Address - Street 2:101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3128
Practice Address - Country:US
Practice Address - Phone:302-429-0195
Practice Address - Fax:302-777-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1000136103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty