Provider Demographics
NPI:1336890219
Name:MONDESTIN, NADIA (LADC, CRC)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:MONDESTIN
Suffix:
Gender:F
Credentials:LADC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 LINDLEY ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4725
Mailing Address - Country:US
Mailing Address - Phone:347-570-3438
Mailing Address - Fax:
Practice Address - Street 1:991 LINDLEY ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4725
Practice Address - Country:US
Practice Address - Phone:347-570-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001264101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)