Provider Demographics
NPI:1902392798
Name:CONDE, JONELLE CRISTINE
Entity Type:Individual
Prefix:
First Name:JONELLE
Middle Name:CRISTINE
Last Name:CONDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 GLEN CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-6448
Mailing Address - Country:US
Mailing Address - Phone:510-541-2254
Mailing Address - Fax:
Practice Address - Street 1:4355 GLEN CANYON CIR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-6448
Practice Address - Country:US
Practice Address - Phone:510-612-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB6260244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst