Provider Demographics
NPI:1407407331
Name:SERRANO MENDOZA, ZULEIKA (LMSW)
Entity Type:Individual
Prefix:
First Name:ZULEIKA
Middle Name:
Last Name:SERRANO MENDOZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10214 LEWIS AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-5153
Mailing Address - Country:US
Mailing Address - Phone:347-606-5608
Mailing Address - Fax:
Practice Address - Street 1:3708 91ST ST STE 3A
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7962
Practice Address - Country:US
Practice Address - Phone:718-779-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106799104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker