Provider Demographics
NPI:1639648611
Name:MENDEZ, MAGDALENA
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 DELILAH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5102
Mailing Address - Country:US
Mailing Address - Phone:609-272-8580
Mailing Address - Fax:
Practice Address - Street 1:210 S SHORE RD STE 201
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1271
Practice Address - Country:US
Practice Address - Phone:609-390-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health