Provider Demographics
NPI:1386366326
Name:MENDOZA, GLADYS Y (LCSW)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:Y
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 1:1525 E NOBLE AVE # 241
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-3043
Mailing Address - Country:US
Mailing Address - Phone:559-368-3198
Mailing Address - Fax:
Practice Address - Street 1:1212 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5917
Practice Address - Country:US
Practice Address - Phone:559-368-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1039561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical