Provider Demographics
NPI:1083813133
Name:MENDES, ELIZABETH SOUCY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SOUCY
Last Name:MENDES
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 1:18 PATRIOT RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06280-1424
Mailing Address - Country:US
Mailing Address - Phone:860-208-6681
Mailing Address - Fax:
Practice Address - Street 1:54 NORTH ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2528
Practice Address - Country:US
Practice Address - Phone:860-450-0151
Practice Address - Fax:860-450-7152
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical