Provider Demographics
NPI:1518637354
Name:RAFFAELE MENDEZ, LINDA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE
Last Name:RAFFAELE MENDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LINDBERGH PKWY
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1327
Mailing Address - Country:US
Mailing Address - Phone:813-695-0541
Mailing Address - Fax:
Practice Address - Street 1:57 LINDBERGH PKWY
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1327
Practice Address - Country:US
Practice Address - Phone:813-695-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012755103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist