Provider Demographics
NPI:1225214711
Name:MANSFIELD, PETRA MENDOZA (LCSW)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:MENDOZA
Last Name:MANSFIELD
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:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:SAN ARDO
Mailing Address - State:CA
Mailing Address - Zip Code:93450-0201
Mailing Address - Country:US
Mailing Address - Phone:831-673-1438
Mailing Address - Fax:
Practice Address - Street 1:1704 SPRING ST STE 202
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1679
Practice Address - Country:US
Practice Address - Phone:831-673-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator