Basic Information
| Provider Information | |||||||||
| NPI: | 1568925980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANDELL | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | DEBORAH | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5330 AMBERWOOD CT | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970358792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036240787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9450 SW BARNES RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032162025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L1372 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.