Healthcare Provider Details

I. General information

NPI: 1003534611
Provider Name (Legal Business Name): MABEL LO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SILVERSIDE RD STE 27
WILMINGTON DE
19809-1375
US

IV. Provider business mailing address

501 SILVERSIDE RD STE 27
WILMINGTON DE
19809-1375
US

V. Phone/Fax

Practice location:
  • Phone: 302-499-2784
  • Fax:
Mailing address:
  • Phone: 302-499-2784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0011438
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number120003
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: