Provider Demographics
NPI:1073968889
Name:MONDILLO, KRYSTAL (MS)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:MONDILLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1280
Mailing Address - Country:US
Mailing Address - Phone:610-417-0463
Mailing Address - Fax:
Practice Address - Street 1:510 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1280
Practice Address - Country:US
Practice Address - Phone:610-417-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor