Provider Demographics
NPI:1538255989
Name:MANDELBAUM, MADELEINE T (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:T
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 QUENTIN DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-6124
Mailing Address - Country:US
Mailing Address - Phone:603-432-0067
Mailing Address - Fax:603-437-2665
Practice Address - Street 1:12 PARMENTER RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3280
Practice Address - Country:US
Practice Address - Phone:603-437-2069
Practice Address - Fax:603-437-5588
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2751041C0700X
MA1061281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11258581OtherAETNA
NH30007950Medicaid
NHNA1394OtherHARVARD PILGRIM
MAP06776OtherBC/BS MA
NH006037OtherHPHC-VALUE OPTIONS
NH65429OtherUNITED BEHAVIORAL HEALTH
NHMAN683192OtherANTHEM BC/BS NH
NH000275OtherTUFTS HEALTH PLAN
NH30007950Medicaid