Ethan C Mandelkern, is a
Social Worker - Clinical based in Mount Shasta, California. Ethan C Mandelkern is licensed to practice in California (license number LCSW64679) and his current practice location is
419 Chestnut St, Suite #2, Mount Shasta, California. He can be reached at his office (for appointments etc.) via phone at
(530) 918-8348.
NPI number for Ethan C Mandelkern is 1023224623 and his current mailing address is 419 Chestnut St, Suite #2, Mount Shasta, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1023224623.
Healthcare Provider's Profile
| Full Name | Ethan C Mandelkern |
|---|
| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 419 Chestnut St, Mount Shasta, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1023224623
- Provider Enumeration Date: 05/14/2007
- Last Update Date: 08/12/2024
Medical Identifiers
Medical identifiers for Ethan C Mandelkern such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1023224623 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YP2500X | Counselor - Professional | LPCC726 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW64679 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ethan C Mandelkern is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ethan C Mandelkern,
419 Chestnut St, Suite #2,
Mount Shasta, CA 96067-2918
Ph: (530) 918-8348 | Ethan C Mandelkern,
419 Chestnut St, Suite #2,
Mount Shasta, CA 96067-2918
Ph: (530) 918-8348 |
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