Provider Demographics
NPI:1336794486
Name:MANDELBAUM, OLIVIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CITPD AT MOUNT SINAI WEST HOSPITAL
Mailing Address - Street 2:1000 10TH AVENUE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:914-424-0909
Mailing Address - Fax:
Practice Address - Street 1:CITPD AT MOUNT SINAI WEST HOSPITAL
Practice Address - Street 2:1000 10TH AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:914-424-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty