Provider Demographics
NPI:1174294110
Name:MONDILLO, MEL THOMAS (RBT)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:THOMAS
Last Name:MONDILLO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10468 INVESTORS PL STE B
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1749
Mailing Address - Country:US
Mailing Address - Phone:757-384-3248
Mailing Address - Fax:540-301-8315
Practice Address - Street 1:10468 INVESTORS PL STE B
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1749
Practice Address - Country:US
Practice Address - Phone:757-384-3248
Practice Address - Fax:540-301-8315
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-185514106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst