Individual
ROBERT MANDELBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
151 PARKWOOD DR, SHIRLEY, NY 11967-3938
(631) 543-6200
Mailing address
151 PARKWOOD DR, SHIRLEY, NY 11967-3938
(631) 543-6200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12388
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02249145
CASAC
NY
Enumeration date
07/17/2007
Last updated
04/05/2010
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