Provider Demographics
NPI:1669142964
Name:MANDELL, GINA (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MANDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3280
Mailing Address - Country:US
Mailing Address - Phone:847-533-0746
Mailing Address - Fax:
Practice Address - Street 1:355 W DUNDEE RD STE 214
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3500
Practice Address - Country:US
Practice Address - Phone:847-533-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490054391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical