Healthcare Provider Details

I. General information

NPI: 1275916579
Provider Name (Legal Business Name): DAVID MANDELBAUM, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 07/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N HARRISON ST 101
WILMINGTON DE
19806-3128
US

IV. Provider business mailing address

1301 N HARRISON ST 101
WILMINGTON DE
19806-3128
US

V. Phone/Fax

Practice location:
  • Phone: 302-429-0195
  • Fax: 302-777-1712
Mailing address:
  • Phone: 302-429-0195
  • Fax: 302-777-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB1000136
License Number StateDE

VIII. Authorized Official

Name: DR. DAVID IRA MANDELBAUM
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 302-429-0195