Provider Demographics
NPI:1942387972
Name:MENDEZ, JOHN (PHD, LCSW, CAP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:PHD, LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7161 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1644
Mailing Address - Country:US
Mailing Address - Phone:954-987-5762
Mailing Address - Fax:
Practice Address - Street 1:1492 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2209
Practice Address - Country:US
Practice Address - Phone:305-541-8435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-50761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical