Individual
CORY MANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 FITZWATERTOWN RD, WILLOW GROVE, PA 19090-1927
(484) 681-2170
Mailing address
630 FITZWATERTOWN RD, WILLOW GROVE, PA 19090-1927
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-104601
PA
Other
Enumeration date
11/27/2019
Last updated
11/27/2019
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