Provider Demographics
NPI:1134439532
Name:CHOPP-MANDELBAUM, BLIMA (LMSW)
Entity type:Individual
Prefix:MS
First Name:BLIMA
Middle Name:
Last Name:CHOPP-MANDELBAUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11783-0037
Mailing Address - Country:US
Mailing Address - Phone:516-781-1911
Mailing Address - Fax:516-781-1173
Practice Address - Street 1:3375 PARK AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3733
Practice Address - Country:US
Practice Address - Phone:516-781-1911
Practice Address - Fax:516-781-1173
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081023-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03003069Medicaid