Provider Demographics
NPI:1528206273
Name:MONDACA, MARISOL ROXANA (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:ROXANA
Last Name:MONDACA
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-4804
Mailing Address - Country:US
Mailing Address - Phone:732-403-1377
Mailing Address - Fax:
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1859
Practice Address - Country:US
Practice Address - Phone:732-403-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00135800101YA0400X
NJ37PC00352800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)