MEDICARE: ELIZABETH MANDERS MA, BC-DMT, LPC

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	101Y00000X	Counselor	PC005513	PA

General Provider Information

NPI Number	:	1346641693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MANDERS MA, BC-DMT, LPC

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:	DREXEL UNIVERSITY, CAT DEPT., MAIL STOP 7905
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-764-6267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CHERRY ST
Second Line	:	DREXEL UNIVERSITY, CAT DEPT., MAIL STOP 7905
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-764-6267
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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