Healthcare Provider Details

I. General information

NPI: 1568371383
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL MANDERS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 PARK AVE STE 205
WANTAGH NY
11793-3733
US

IV. Provider business mailing address

3366 PARK AVE STE 205
WANTAGH NY
11793-3718
US

V. Phone/Fax

Practice location:
  • Phone: 516-973-1032
  • Fax:
Mailing address:
  • Phone: 516-973-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131904-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: