Provider Demographics
NPI:1972774941
Name:MONDELLO, DEBORAH FALK (MS, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:FALK
Last Name:MONDELLO
Suffix:
Gender:F
Credentials:MS, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD MILL PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4254
Mailing Address - Country:US
Mailing Address - Phone:914-773-7434
Mailing Address - Fax:
Practice Address - Street 1:228 LINDA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2050
Practice Address - Country:US
Practice Address - Phone:914-773-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001129-1322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children