Provider Demographics
NPI:1578126553
Name:MENDEZ, SUHEILY (MASTERS CLINICAL SW)
Entity Type:Individual
Prefix:
First Name:SUHEILY
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MASTERS CLINICAL SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 17231
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9569
Mailing Address - Country:US
Mailing Address - Phone:787-371-2417
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 17231
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9569
Practice Address - Country:US
Practice Address - Phone:787-371-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherNOT REQUIRED