Provider Demographics
NPI:1194155119
Name:MONDELBLATT, ADAM (EDS, MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MONDELBLATT
Suffix:
Gender:M
Credentials:EDS, MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E MAIN STREEET
Mailing Address - Street 2:MARLTON
Mailing Address - City:NJ
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:609-613-0110
Mailing Address - Fax:866-309-4180
Practice Address - Street 1:34 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2157
Practice Address - Country:US
Practice Address - Phone:856-751-0505
Practice Address - Fax:888-399-1804
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00485700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional