Individual
MICAH MAMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
1600 W CHANDLER BLVD STE 110, CHANDLER, AZ 85224-6100
(480) 524-0990
Mailing address
1600 W CHANDLER BLVD STE 110, CHANDLER, AZ 85224-6100
(480) 524-0990
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-005068
AZ
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
05/03/2017
Last updated
12/08/2021
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