MEDICARE: IRENE MANTELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC04578800	NJ
2	1041C0700X	Clinical Social Worker	052408-1	NY

General Provider Information

NPI Number	:	1114021821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE MANTELL LCSW

Provider Business Mailing Address
First Line	:	5 CHERRY TREE LN
Second Line	:
City	:	KINNELON
State	:	NJ
Zip	:	07405-2214
Country	:	US
Telephone Number	:	973-492-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CHERRY TREE LN
Second Line	:
City	:	KINNELON
State	:	NJ
Zip	:	07405-2214
Country	:	US
Telephone Number	:	973-492-3404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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