Provider Demographics
NPI:1790112829
Name:MONDOLFI, UBERTO LEONE (, NCC, MCAP, NGCII)
Entity Type:Individual
Prefix:DR
First Name:UBERTO
Middle Name:LEONE
Last Name:MONDOLFI
Suffix:
Gender:M
Credentials:, NCC, MCAP, NGCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S DIXIE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2455
Mailing Address - Country:US
Mailing Address - Phone:786-366-2311
Mailing Address - Fax:
Practice Address - Street 1:2000 S DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2455
Practice Address - Country:US
Practice Address - Phone:786-366-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC011559101YA0400X
FLMH14401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)