MEDICARE: MR. BRIAN MARTIN MANDEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R048865	NY
2	1041C0700X	Clinical Social Worker	SW13299	FL

General Provider Information

NPI Number	:	1033261656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN MARTIN MANDEL LCSW

Provider Business Mailing Address
First Line	:	4000 HOLLYWOOD BLVD STE 715S
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6755
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 HOLLYWOOD BLVD STE 715S
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6755
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	10/29/2025

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