Provider Demographics
NPI:1558825679
Name:GONZALEZ MENDEZ, ALEXIS (MED, MBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GONZALEZ MENDEZ
Suffix:
Gender:M
Credentials:MED, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 PLEASANT VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3517
Mailing Address - Country:US
Mailing Address - Phone:401-215-8278
Mailing Address - Fax:
Practice Address - Street 1:134 THURBERS AVE STE 212
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4721
Practice Address - Country:US
Practice Address - Phone:401-453-7618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor