Healthcare Provider Details

I. General information

NPI: 1336794486
Provider Name (Legal Business Name): OLIVIA MANDELBAUM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 EAST AVE
NORWALK CT
06851-4904
US

IV. Provider business mailing address

69 EAST AVE
NORWALK CT
06851-4904
US

V. Phone/Fax

Practice location:
  • Phone: 914-424-0909
  • Fax:
Mailing address:
  • Phone: 914-424-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023312
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3999
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: