Provider Demographics
NPI:1689956153
Name:MANDELBAUM, CHANA E (MS SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:CHANA
Middle Name:E
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:MS
Other - First Name:CHANA
Other - Middle Name:E
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-SLP
Mailing Address - Street 1:172 WILLIAMSBURG LANE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-534-5740
Mailing Address - Fax:
Practice Address - Street 1:2132 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-339-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist