Provider Demographics
NPI:1841280435
Name:MANDEL, RAYMOND P (PHD)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:P
Last Name:MANDEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 COUNTY ROAD 83
Mailing Address - Street 2:P.O. BOX 322
Mailing Address - City:CANBY
Mailing Address - State:CA
Mailing Address - Zip Code:96015-9722
Mailing Address - Country:US
Mailing Address - Phone:530-233-4135
Mailing Address - Fax:530-233-4140
Practice Address - Street 1:670 COUNTY ROAD 83
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:CA
Practice Address - Zip Code:96015-9722
Practice Address - Country:US
Practice Address - Phone:530-233-4135
Practice Address - Fax:530-233-4140
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY05991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY15991OtherLCP
CAPSY15991OtherLCP
CAPSY15991OtherLCP