Provider Demographics
NPI:1386943249
Name:MANDEL, SHOSHANA ELISE (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:ELISE
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 WESTVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9737
Mailing Address - Country:US
Mailing Address - Phone:734-604-9301
Mailing Address - Fax:734-222-9221
Practice Address - Street 1:1012 EAST HALL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-604-9301
Practice Address - Fax:734-222-9221
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010872001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical