Provider Demographics
NPI:1871901439
Name:MANDEL, ELI EPHRAIM (MSW, LSW)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:EPHRAIM
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 PINE ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6164
Mailing Address - Country:US
Mailing Address - Phone:210-365-5787
Mailing Address - Fax:
Practice Address - Street 1:21 S 12TH ST
Practice Address - Street 2:8TH FL.
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3614
Practice Address - Country:US
Practice Address - Phone:210-365-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker