Provider Demographics
NPI:1467177303
Name:MENDOZA, AMANDA (CBHCMS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 PONCE DE LEON BLVD STE 324
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2050
Mailing Address - Country:US
Mailing Address - Phone:786-343-6493
Mailing Address - Fax:305-397-1271
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 324
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2050
Practice Address - Country:US
Practice Address - Phone:786-343-6493
Practice Address - Fax:305-397-1271
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker