Provider Demographics
NPI:1801058664
Name:MANDELMAN, LISA ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:MANDELMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 1/2 PARKHILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5117
Mailing Address - Country:US
Mailing Address - Phone:203-856-7440
Mailing Address - Fax:203-642-3871
Practice Address - Street 1:35 1/2 PARKHILL AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5117
Practice Address - Country:US
Practice Address - Phone:203-856-7440
Practice Address - Fax:203-642-3871
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist