Healthcare Provider Details

I. General information

NPI: 1801245071
Provider Name (Legal Business Name): NICOLE SOLIMINE MONDRONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 DOVECOTE LN
COMMACK NY
11725-2748
US

IV. Provider business mailing address

92 DOVECOTE LN
COMMACK NY
11725-2748
US

V. Phone/Fax

Practice location:
  • Phone: 631-462-2465
  • Fax:
Mailing address:
  • Phone: 631-462-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000164-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number000164-1
License Number StateNY

VIII. Authorized Official

Name: NICOLE MONDRONE
Title or Position: BCBA
Credential:
Phone: 516-492-7066