Provider Demographics
NPI:1245864362
Name:MONDESIR, OLGA J
Entity type:Individual
Prefix:MS
First Name:OLGA
Middle Name:J
Last Name:MONDESIR
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 1:133-16 143RD STREET
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436
Mailing Address - Country:US
Mailing Address - Phone:718-751-6590
Mailing Address - Fax:718-322-3026
Practice Address - Street 1:133-16 143RD STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436
Practice Address - Country:US
Practice Address - Phone:718-751-6590
Practice Address - Fax:718-322-3026
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional