Healthcare Provider Details

I. General information

NPI: 1952711202
Provider Name (Legal Business Name): MATTHEW GARY MANDELBAUM PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 OLD KINGS HWY S # 1055
DARIEN CT
06820-4526
US

IV. Provider business mailing address

30 OLD KINGS HWY S # 1055
DARIEN CT
06820-4526
US

V. Phone/Fax

Practice location:
  • Phone: 212-933-0758
  • Fax: 347-983-7242
Mailing address:
  • Phone: 212-933-0758
  • Fax: 347-983-7242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: