Active NPI
Kimberly Mandel
- Clinical Psychologist
- Camp Lejeune, NC
National Provider Identifier
1790001196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3705
- Practice address
- 100 Brewster Blvd
Naval Hosptial
Camp Lejeune, NC 28547-2538 - Phone
- (910) 450-4136
- NPI assigned
- Apr 12, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3705 | NC | Primary |
Addresses
Primary practice location
100 Brewster Blvd
Naval Hosptial
Camp Lejeune, NC 28547-2538
Mailing address
100 Brewster Blvd
Naval Hosptial
Camp Lejeune, NC 28547-2538
Phone (910) 450-4136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3705 | NC | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1790001196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"address_2": "NAVAL HOSPTIAL",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472538",
"telephone_number": "910-450-4136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"address_2": "NAVAL HOSPTIAL",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472538",
"telephone_number": "910-450-4136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDEL",
"first_name": "KIMBERLY",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-12",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Lejeune, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.