Active NPI
Julie Gardner Mandel, PHD
- Clinical Psychologist
- Newton Highlands, MA
National Provider Identifier
1720062730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6776
- Practice address
- 100 Woodcliff Rd
Newton Highlands, MA 02461-1845 - Phone
- (617) 733-5438
- NPI assigned
- Dec 2, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6776 | MA | |
| Clinical Psychologist | 103TC0700X | 6776 | MA | Primary |
Addresses
Primary practice location
100 Woodcliff Rd
Newton Highlands, MA 02461-1845
Mailing address
100 Woodcliff Rd
Newton Highlands, MA 02461-1845
Phone (617) 733-5438
Other names 1
- Julie Anne Gardner
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 24, 2024 through Jan 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6776 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704499200000",
"number": "1720062730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 WOODCLIFF RD",
"city": "NEWTON HIGHLANDS",
"state": "MA",
"postal_code": "024611845",
"telephone_number": "617-733-5438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WOODCLIFF RD",
"city": "NEWTON HIGHLANDS",
"state": "MA",
"postal_code": "024611845",
"telephone_number": "617-733-5438"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDEL",
"first_name": "JULIE",
"middle_name": "GARDNER",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-02",
"last_updated": "2024-01-06",
"certification_date": "2024-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "6776",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "6776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JULIE",
"last_name": "GARDNER",
"middle_name": "ANNE",
"credential": "PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Newton Highlands, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2024; 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.