Provider Demographics
NPI:1306140777
Name:MONGIELLO, BART (LCSW)
Entity type:Individual
Prefix:MR
First Name:BART
Middle Name:
Last Name:MONGIELLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LIBBY AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1610
Mailing Address - Country:US
Mailing Address - Phone:973-839-7096
Mailing Address - Fax:
Practice Address - Street 1:301 SICOMAC AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2159
Practice Address - Country:US
Practice Address - Phone:201-848-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001685001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical