Provider Demographics
NPI:1568845691
Name:MENDEZ, MARISOL (AA, BA, MPA)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:AA, BA, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 STAR SHOWER CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9433
Mailing Address - Country:US
Mailing Address - Phone:407-683-3470
Mailing Address - Fax:
Practice Address - Street 1:3579 STAR SHOWER CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9433
Practice Address - Country:US
Practice Address - Phone:407-683-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst