Provider Demographics
NPI:1942633821
Name:MENDEZ, STEPHANIE ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11154
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-1154
Mailing Address - Country:US
Mailing Address - Phone:323-876-0550
Mailing Address - Fax:323-637-5001
Practice Address - Street 1:3580 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2505
Practice Address - Country:US
Practice Address - Phone:323-876-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAASW682741041C0700X
CA1924521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health