Provider Demographics
NPI:1598034159
Name:MONGOLD, CAROL BABASH (MS,ED)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:BABASH
Last Name:MONGOLD
Suffix:
Gender:F
Credentials:MS,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MOUNTAIN ACRES LOOP
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-8146
Mailing Address - Country:US
Mailing Address - Phone:304-434-2475
Mailing Address - Fax:
Practice Address - Street 1:211 MOUNTAIN ACRES LOOP
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8146
Practice Address - Country:US
Practice Address - Phone:304-434-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist