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General NPI Number Information
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NPI Number | 1962494096
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Entity Type | Individual
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Provider Name | RISA M. MANDELL MSW
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 1200 W GODFREY AVE STE 3100
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3323
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Country | US
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Telephone | 215-444-7469
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Fax | 215-444-7469
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Provider Business Mailing Address
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Address Line | PO BOX 746722
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City | ATLANTA
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State | GA
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Zip | 30374-6722
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW015651
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License Number State | PA
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