Provider Demographics
NPI:1508273921
Name:MENDEZ, BERTA (MA)
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 MAIN STREET. HELLERTOWN, PA 18055
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:18055
Mailing Address - Country:US
Mailing Address - Phone:610-838-2880
Mailing Address - Fax:
Practice Address - Street 1:1422 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1351
Practice Address - Country:US
Practice Address - Phone:610-838-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2015-07-08
Deactivation Date:2014-08-07
Deactivation Code:
Reactivation Date:2015-07-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor