Provider Demographics
NPI:1720417256
Name:MENDOZA, MARIBEL (BSW)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:VASQUEZ CARMONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5301 TIETON DRIVE, SUITE C
Mailing Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:5301 TIETON DRIVE, SUITE C
Practice Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-9750
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG604206961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical