Provider Demographics
NPI:1609817519
Name:MENDOZA, MARILYN ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ALLEN
Last Name:MENDOZA
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 1:3221 BEHRMAN PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8200
Mailing Address - Country:US
Mailing Address - Phone:504-363-0203
Mailing Address - Fax:504-363-0204
Practice Address - Street 1:3221 BEHRMAN PL
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8200
Practice Address - Country:US
Practice Address - Phone:504-363-0203
Practice Address - Fax:504-363-0204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T057Medicare ID - Type Unspecified