Michael R. Mantell, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 5020 Issued in CA

Practice address

5565 Grossmont Center Dr
Building 1, Suite 223
La Mesa, CA 91942-3020

Phone

(619) 644-1111

Fax

(619) 644-1115

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael R. Mantell, PH. D., Inc

  • Psychologist
  • La Mesa, CA
  • NPI 1457657652
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296777600000",
    "number": "1811928559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BUILDING 1, SUITE 223",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-644-1111",
            "fax_number": "619-644-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BUILDING 1, SUITE 223",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-644-1111",
            "fax_number": "619-644-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTELL",
        "first_name": "MICHAEL",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2011-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 5020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2436992",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.