Healthcare Provider Details

I. General information

NPI: 1083822746
Provider Name (Legal Business Name): DEBRA DONNENBERG MANDEL MS,ATR,SAS,SDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E 7TH ST
BROOKLYN NY
11230-2209
US

IV. Provider business mailing address

885 E 7TH ST
BROOKLYN NY
11230-2209
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-2004
  • Fax: 718-338-2075
Mailing address:
  • Phone: 718-258-2004
  • Fax: 718-338-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004013-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number118814862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: