Provider Demographics
NPI:1558801407
Name:MENDONCA, LUDMILA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:MENDONCA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 RAMBLEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 LAUREL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2330
Practice Address - Country:US
Practice Address - Phone:732-406-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL0589600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker