Provider Demographics
NPI:1295223519
Name:MENDILLO, TONI A (LAC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:A
Last Name:MENDILLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GEORGIA TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9018
Mailing Address - Country:US
Mailing Address - Phone:609-744-3607
Mailing Address - Fax:
Practice Address - Street 1:212 BARCLAY PAVILION E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2137
Practice Address - Country:US
Practice Address - Phone:609-744-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00384200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health