Provider Demographics
NPI:1891144150
Name:MONDO, JOSEPH (MA/AC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MONDO
Suffix:
Gender:M
Credentials:MA/AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-3644
Mailing Address - Country:US
Mailing Address - Phone:716-472-9322
Mailing Address - Fax:
Practice Address - Street 1:3600 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5124
Practice Address - Country:US
Practice Address - Phone:716-686-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool