Provider Demographics
NPI:1275040990
Name:MENDES, MARIA J
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:MENDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1052
Mailing Address - Country:US
Mailing Address - Phone:617-445-4075
Mailing Address - Fax:
Practice Address - Street 1:1059 TREMONT ST STE 2
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2193
Practice Address - Country:US
Practice Address - Phone:617-445-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator