Provider Demographics
NPI:1407113939
Name:MESA, WENDY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3102
Mailing Address - Country:US
Mailing Address - Phone:321-693-3679
Mailing Address - Fax:
Practice Address - Street 1:580 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BCH
Practice Address - State:FL
Practice Address - Zip Code:32937-3102
Practice Address - Country:US
Practice Address - Phone:321-693-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2012-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health