Provider Demographics
NPI:1952069056
Name:MENDEZ RODRIGUEZ, DIALYS MABEL
Entity Type:Individual
Prefix:
First Name:DIALYS
Middle Name:MABEL
Last Name:MENDEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 3RD AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3732
Mailing Address - Country:US
Mailing Address - Phone:646-965-0892
Mailing Address - Fax:
Practice Address - Street 1:2490 3RD AVE APT 3G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3732
Practice Address - Country:US
Practice Address - Phone:646-965-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling