Healthcare Provider Details

I. General information

NPI: 1952284564
Provider Name (Legal Business Name): PHOENIX MANDEL AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BELLEVUE AVE STE 202C
OAKLAND CA
94610-4923
US

IV. Provider business mailing address

40 LANE CT
OAKLAND CA
94611-3129
US

V. Phone/Fax

Practice location:
  • Phone: 347-489-1996
  • Fax:
Mailing address:
  • Phone: 310-256-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: