Provider Demographics
NPI:1134694789
Name:MENDOZA, ADA (LMSW)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129A OREGON RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1249
Mailing Address - Country:US
Mailing Address - Phone:914-788-4058
Mailing Address - Fax:
Practice Address - Street 1:129A OREGON RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1249
Practice Address - Country:US
Practice Address - Phone:914-788-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078549104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker