Provider Demographics
NPI:1104451640
Name:MENDOZA, MARIA J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6861 YELLOWSTONE BLVD STE 106A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3313
Mailing Address - Country:US
Mailing Address - Phone:917-604-6839
Mailing Address - Fax:516-977-3542
Practice Address - Street 1:6861 YELLOWSTONE BLVD STE 106A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3313
Practice Address - Country:US
Practice Address - Phone:917-604-6839
Practice Address - Fax:516-977-3542
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0887731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty