Provider Demographics
NPI:1366655367
Name:MENDELL, PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:MENDELL
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 1:90 8TH AVE
Mailing Address - Street 2:8A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1553
Mailing Address - Country:US
Mailing Address - Phone:718-230-9383
Mailing Address - Fax:212-302-8532
Practice Address - Street 1:902 BROADWAY
Practice Address - Street 2:13TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6002
Practice Address - Country:US
Practice Address - Phone:212-819-1778
Practice Address - Fax:212-302-8532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO16946-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145146Medicare UPIN
NY0020820Medicare UPIN