Provider Demographics
NPI:1417235565
Name:MENDOZA, VANESSA NORMA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:NORMA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:VANESSA
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2999 OVERLAND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4243
Mailing Address - Country:US
Mailing Address - Phone:310-957-5641
Mailing Address - Fax:
Practice Address - Street 1:2999 OVERLAND AVE STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4243
Practice Address - Country:US
Practice Address - Phone:310-957-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA702031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health