Provider Demographics
NPI:1871087197
Name:MANDELL, ASHLEY (MAT BCBA, LBA-NY)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:MANDELL
Suffix:
Gender:F
Credentials:MAT BCBA, LBA-NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WYCKOFF ST APT 16
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6341
Mailing Address - Country:US
Mailing Address - Phone:847-528-8764
Mailing Address - Fax:
Practice Address - Street 1:124 W 95TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6604
Practice Address - Country:US
Practice Address - Phone:847-528-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001533103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst