Provider Demographics
NPI:1891245155
Name:MENDEZ, TARA TORRES (MSW)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:TORRES
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7551
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9368
Mailing Address - Country:US
Mailing Address - Phone:787-429-7074
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE PATRON
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3021
Practice Address - Country:US
Practice Address - Phone:787-862-3000
Practice Address - Fax:787-862-2731
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401807OtherFQHC
PR82747Medicare PIN