Provider Demographics
NPI:1093207516
Name:ARRENDELL, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ARRENDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 40TH ST BSMT
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3823
Mailing Address - Country:US
Mailing Address - Phone:646-670-3690
Mailing Address - Fax:
Practice Address - Street 1:9609 40TH RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2138
Practice Address - Country:US
Practice Address - Phone:929-522-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health