Provider Demographics
NPI:1346421583
Name:MENDOZA, ERIN LACY (PSYD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LACY
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 W FRONT ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1155
Mailing Address - Country:US
Mailing Address - Phone:732-779-1725
Mailing Address - Fax:
Practice Address - Street 1:210 W FRONT ST
Practice Address - Street 2:SUITE 208
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1155
Practice Address - Country:US
Practice Address - Phone:732-779-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017925103TC0700X
NJ35S100509700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical