Provider Demographics
NPI:1407946114
Name:MANTEL, BARBARA (MSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:MANTEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 WACHUSETT ST # 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4139
Mailing Address - Country:US
Mailing Address - Phone:617-522-5494
Mailing Address - Fax:
Practice Address - Street 1:2 BREWER ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5710
Practice Address - Country:US
Practice Address - Phone:617-576-6909
Practice Address - Fax:617-576-6909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1004701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMMP21923Medicare ID - Type Unspecified