Provider Demographics
NPI:1700214491
Name:MANDEL, KATHRYN LYNN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:MANDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:CARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 W THOUSAND OAKS BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4463
Mailing Address - Country:US
Mailing Address - Phone:805-777-3553
Mailing Address - Fax:
Practice Address - Street 1:125 W THOUSAND OAKS BLVD STE 600
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4463
Practice Address - Country:US
Practice Address - Phone:805-777-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist