Provider Demographics
NPI:1457174104
Name:MONDLAK, DEBORAH
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:MONDLAK
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 1:16901 COLLINS AVE APT 5305
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5358
Mailing Address - Country:US
Mailing Address - Phone:305-680-8022
Mailing Address - Fax:
Practice Address - Street 1:16901 COLLINS AVE APT 5305
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-5358
Practice Address - Country:US
Practice Address - Phone:305-680-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW204841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical