Healthcare Provider Details

I. General information

NPI: 1154243830
Provider Name (Legal Business Name): JOSEPH MONGILLO LPC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

IV. Provider business mailing address

892 FARMINGTON AVE # 892A
WEST HARTFORD CT
06119-1421
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-1357
Mailing address:
  • Phone: 860-456-2261
  • Fax: 860-450-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7369
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: