Provider Demographics
NPI:1366920175
Name:MONDELLO, GABRIELLE M
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:M
Last Name:MONDELLO
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 1:1735 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3323
Mailing Address - Country:US
Mailing Address - Phone:813-550-8055
Mailing Address - Fax:
Practice Address - Street 1:1735 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3323
Practice Address - Country:US
Practice Address - Phone:813-550-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician