Provider Demographics
NPI:1790831105
Name:MANDEL, EMANUEL (LCSWC)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:MANDEL
Suffix:
Gender:M
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 GEORGIA AVE
Mailing Address - Street 2:#808
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-495-5570
Mailing Address - Fax:301-460-0295
Practice Address - Street 1:8720 GEORGIA AVE
Practice Address - Street 2:#808
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:301-495-5570
Practice Address - Fax:301-460-0295
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD#12651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD646369Medicare ID - Type Unspecified