Provider Demographics
NPI:1134646482
Name:MENDES, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MENDES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:MENDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:7000 N FEDERAL HWY FL 1
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1644
Mailing Address - Country:US
Mailing Address - Phone:561-353-9382
Mailing Address - Fax:
Practice Address - Street 1:2330 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7608
Practice Address - Country:US
Practice Address - Phone:561-432-5849
Practice Address - Fax:561-432-9732
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health