Provider Demographics
NPI:1659722965
Name:MENDOZA, SALLY (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:MENDOZA-SALVATIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 HACKBERRY PL
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-3003
Mailing Address - Country:US
Mailing Address - Phone:908-399-0466
Mailing Address - Fax:
Practice Address - Street 1:24 MINE ST
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-6500
Practice Address - Country:US
Practice Address - Phone:908-399-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06144300101YM0800X
NJ44SC058061001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical