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General NPI Number Information
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NPI Number | 1932745965
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Entity Type | Individual
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Provider Name | JESSICA MANTELL M.S., C.N.S., L.D.N
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 1300 BRICKELL BAY DR APT 1204
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City | MIAMI
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State | FL
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Zip | 33131-3385
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Country | US
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Telephone | 610-812-3543
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 BRICKELL BAY DR APT 1204
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City | MIAMI
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State | FL
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Zip | 33131-3385
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Country | US
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Telephone | 610-812-3543
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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