Provider Demographics
NPI:1578926952
Name:HARTZ-MANDELL, KARYN (PHD)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:HARTZ-MANDELL
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:1011 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BRADLEY RESEARCH CENTER, CORO WEST, SUITE 204, 2.115
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5061
Mailing Address - Country:US
Mailing Address - Phone:401-793-8860
Mailing Address - Fax:401-793-8799
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:CORO WEST, SUITE 204, 2.115
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-793-8860
Practice Address - Fax:401-793-8799
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2023-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY24448363AM0700X
RIPS01550103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical