Provider Demographics
NPI:1851453484
Name:MANDEL, SUSAN M (PSYD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:MANDEL
Suffix:
Gender:F
Credentials:PSYD,LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYDLCSW
Mailing Address - Street 1:18 E CHERYL RD
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9425
Mailing Address - Country:US
Mailing Address - Phone:973-227-2340
Mailing Address - Fax:973-227-2330
Practice Address - Street 1:1279 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4904
Practice Address - Country:US
Practice Address - Phone:973-334-0577
Practice Address - Fax:973-227-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00025001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ637623Medicare ID - Type Unspecified