Healthcare Provider Details

I. General information

NPI: 1194155119
Provider Name (Legal Business Name): ADAM MONDELBLATT ED.S, MA, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WHITE HORSE RD STE 304
VOORHEES NJ
08043-4409
US

IV. Provider business mailing address

34 E MAIN STREEET MARLTON
NJ NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-866-6331
  • Fax:
Mailing address:
  • Phone: 609-613-0110
  • Fax: 866-309-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00485700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: