Active NPI
Jessica Eden Mandell, PHD
- Psychologist
- Charlotte, NC
National Provider Identifier
1376289629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6743
- Practice address
- 1515 Mockingbird LN Ste 580
Charlotte, NC 28209-1171 - Phone
- (704) 910-8381
- Fax
- (704) 981-8282
- NPI assigned
- May 10, 2022
- Last updated
- Apr 4, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6743 | NC | Primary |
Addresses
Primary practice location
1515 Mockingbird LN Ste 580
Charlotte, NC 28209-1171
Mailing address
1515 Mockingbird LN Ste 580
Charlotte, NC 28209-1171
Phone (704) 910-8381
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 18, 2025 through Feb 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6743 | NC | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Base, PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743724800000",
"number": "1376289629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 MOCKINGBIRD LN STE 580",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282091171",
"telephone_number": "704-910-8381",
"fax_number": "704-981-8282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 MOCKINGBIRD LN STE 580",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282091171",
"telephone_number": "704-910-8381",
"fax_number": "704-981-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDELL",
"first_name": "JESSICA",
"middle_name": "EDEN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-10",
"last_updated": "2025-04-04",
"certification_date": "2025-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "6743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.