Provider Demographics
NPI:1518485945
Name:MENDELSON, RISA RAE (MA, LLPC, COTA)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:RAE
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:MA, LLPC, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 SANCROFT AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324
Mailing Address - Country:US
Mailing Address - Phone:248-366-7445
Mailing Address - Fax:
Practice Address - Street 1:3638 SANCROFT AVE
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-2655
Practice Address - Country:US
Practice Address - Phone:248-342-3973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional