Provider Demographics
NPI:1326441064
Name:MENDOZA, MELISSA E (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:E
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:25600 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0944
Mailing Address - Country:US
Mailing Address - Phone:833-746-5779
Mailing Address - Fax:833-233-3547
Practice Address - Street 1:25600 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0944
Practice Address - Country:US
Practice Address - Phone:833-746-5779
Practice Address - Fax:833-233-3547
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010916001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical