MEDICARE: JESSICA MANTELL M.S., C.N.S., L.D.N

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1932745965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MANTELL M.S., C.N.S., L.D.N

Provider Business Mailing Address
First Line	:	1300 BRICKELL BAY DR APT 1204
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3385
Country	:	US
Telephone Number	:	610-812-3543
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 BRICKELL BAY DR APT 1204
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3385
Country	:	US
Telephone Number	:	610-812-3543
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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