Provider Demographics
NPI:1245862606
Name:MONGILLO, DEBORAH CHRISTINE (MA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CHRISTINE
Last Name:MONGILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1246
Mailing Address - Country:US
Mailing Address - Phone:860-216-8565
Mailing Address - Fax:
Practice Address - Street 1:139 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-216-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist