Provider Demographics
NPI:1982254900
Name:GARCIA-RONDELLI, ILONA (LMHC)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:GARCIA-RONDELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GENESEE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4315
Mailing Address - Country:US
Mailing Address - Phone:347-262-2780
Mailing Address - Fax:
Practice Address - Street 1:39 GENESEE ST BSMT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4315
Practice Address - Country:US
Practice Address - Phone:347-262-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008602-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty