Provider Demographics
NPI:1841184710
Name:MONGO, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MONGO
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 1:117 BANDOL ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2079
Mailing Address - Country:US
Mailing Address - Phone:561-633-9307
Mailing Address - Fax:561-633-9307
Practice Address - Street 1:1551 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3269
Practice Address - Country:US
Practice Address - Phone:407-349-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health