Provider Demographics
NPI:1407067440
Name:MANDEL, DAVID MARC (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARC
Last Name:MANDEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 H ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-3723
Mailing Address - Country:US
Mailing Address - Phone:707-465-1585
Mailing Address - Fax:707-458-4220
Practice Address - Street 1:508 H ST STE 3
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3723
Practice Address - Country:US
Practice Address - Phone:707-465-1585
Practice Address - Fax:707-458-4220
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPL #3526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical