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General NPI Number Information
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NPI Number | 1164750683
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Entity Type | Individual
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Provider Name | JAMES MANDALA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | NEW JERSEY INSTITUTE OF TECHNOLOGY DREW UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICES
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City | NEWARK
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State | NJ
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Zip | 07940-1434
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Country | US
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Telephone | 973-596-3415
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Fax | 973-408-3750
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Provider Business Mailing Address
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Address Line | CAMPBELL HALL 205 NEW JERSEY INSTITUTE OF TECHNOLOGY
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City | NEWARK
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State | NJ
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Zip | 07102
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Country | US
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Telephone | 973-596-3415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00275000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00275000
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License Number State | NJ
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