Provider Demographics
NPI:1659416089
Name:MENDOZA, ELIZA VICTORIA (LCSW/LISW)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:VICTORIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LCSW/LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7461 UMBRIA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3506
Mailing Address - Country:US
Mailing Address - Phone:915-490-5440
Mailing Address - Fax:
Practice Address - Street 1:7461 UMBRIA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-3506
Practice Address - Country:US
Practice Address - Phone:915-490-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX517581041C0700X
TXI06655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker