Provider Demographics
NPI:1255529897
Name:MANDELL, HAVI BRYSK (PHD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:HAVI
Middle Name:BRYSK
Last Name:MANDELL
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4794 S EASTERN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6145
Mailing Address - Country:US
Mailing Address - Phone:702-732-0304
Mailing Address - Fax:702-794-2033
Practice Address - Street 1:4794 S EASTERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6145
Practice Address - Country:US
Practice Address - Phone:702-732-0304
Practice Address - Fax:702-794-2033
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5276-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881724250OtherJFSA