Provider Demographics
NPI:1457776403
Name:MANDON, CHRISTY ELIZABETH (MA BCABA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:ELIZABETH
Last Name:MANDON
Suffix:
Gender:F
Credentials:MA BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 GHARKEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6019
Mailing Address - Country:US
Mailing Address - Phone:415-632-8801
Mailing Address - Fax:
Practice Address - Street 1:7887 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3900
Practice Address - Country:US
Practice Address - Phone:831-688-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-09-3690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst