Provider Demographics
NPI:1871374058
Name:MANDERBACH, KI MARI
Entity type:Individual
Prefix:
First Name:KI
Middle Name:MARI
Last Name:MANDERBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 W MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2930
Mailing Address - Country:US
Mailing Address - Phone:610-616-5890
Mailing Address - Fax:
Practice Address - Street 1:142 W MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2930
Practice Address - Country:US
Practice Address - Phone:610-616-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist