Provider Demographics
NPI:1376797290
Name:MANSBACH, ALIX L (PSYD)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:L
Last Name:MANSBACH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CONNECTICUT AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5841
Mailing Address - Country:US
Mailing Address - Phone:240-424-0184
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE STE 1000
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5841
Practice Address - Country:US
Practice Address - Phone:240-424-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376797290OtherNPI