Provider Demographics
NPI:1386095685
Name:MENDEZ, VERONICA (LCSW, 98809)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LCSW, 98809
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, 98809
Mailing Address - Street 1:3200 MOTOR AVE
Mailing Address - Street 2:VISTA DEL MAR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1533 EUCLID ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3306
Practice Address - Country:US
Practice Address - Phone:305-451-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA988091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical