Doctor Name: | DR. LAWRENCE J MANDT |
NPI Number: | 1255361002 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 20040245 |
Business Practice Address: | 6000 Monona Drive Suite 203 Monona, WI - 537162634 |
Business Phone Number: | 6082239767 |
Business Fax Number: | |
Mailing Address: | 2254 Monroe St, MADISON |
State: | WI |
Postal Code: | 537111902 |
Phone Number: | 6082560398 |
Fax Number: | |
NPI Enumeration Date: | 07/04/2006 |
NPI Last Update Date: | 11/19/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 20040245 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |