Provider Demographics
NPI:1952044232
Name:MENNELLA, GINA ANITA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ANITA
Last Name:MENNELLA
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 1:3226 IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3705
Mailing Address - Country:US
Mailing Address - Phone:917-325-0590
Mailing Address - Fax:
Practice Address - Street 1:3226 IRWIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3705
Practice Address - Country:US
Practice Address - Phone:917-325-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst