Provider Demographics
NPI:1922158781
Name:MENDEZ, HEATHER C (MA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:C
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1204
Mailing Address - Country:US
Mailing Address - Phone:845-256-0096
Mailing Address - Fax:
Practice Address - Street 1:22 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1204
Practice Address - Country:US
Practice Address - Phone:845-256-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health