Provider Demographics
NPI:1740881176
Name:DGMANDEL A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:DGMANDEL A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW, LCSW
Authorized Official - Phone:323-325-5346
Mailing Address - Street 1:137 N LARCHMONT BLVD # 476
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3704
Mailing Address - Country:US
Mailing Address - Phone:323-325-5346
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 439
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3628
Practice Address - Country:US
Practice Address - Phone:310-579-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty