Provider Demographics
NPI:1326651324
Name:MANDARINO, CAROLA SUE
Entity Type:Individual
Prefix:
First Name:CAROLA
Middle Name:SUE
Last Name:MANDARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1426
Mailing Address - Country:US
Mailing Address - Phone:304-243-5702
Mailing Address - Fax:
Practice Address - Street 1:48 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-1426
Practice Address - Country:US
Practice Address - Phone:304-243-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator