Provider Demographics
NPI:1932483658
Name:MANDEL, DOLORES (LCSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34 PARK ST
Mailing Address - Street 2:RM 161
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1109
Mailing Address - Country:US
Mailing Address - Phone:203-974-7098
Mailing Address - Fax:203-974-7493
Practice Address - Street 1:1 LONG WHARF DRIVE SUITE 7
Practice Address - Street 2:FORENSIC DRUG DIVERSION PROGRAM
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-974-5722
Practice Address - Fax:203-974-5705
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical