Provider Demographics
NPI:1952053977
Name:BRUNO MENDEZ, MARIELIS (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIELIS
Middle Name:
Last Name:BRUNO MENDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-2779
Mailing Address - Country:US
Mailing Address - Phone:203-843-3970
Mailing Address - Fax:
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3986
Practice Address - Country:US
Practice Address - Phone:203-777-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6233104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker