Provider Demographics
NPI:1760880942
Name:MENDEZ, LESLY A (CPL)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:A
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE MALLORCA #160
Mailing Address - Street 2:URB. DORAVILLE
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-549-7357
Mailing Address - Fax:787-794-4646
Practice Address - Street 1:CARR. 865 #19A
Practice Address - Street 2:CAMPANILLAS
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951
Practice Address - Country:US
Practice Address - Phone:787-444-0403
Practice Address - Fax:787-794-4646
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional