Provider Demographics
NPI:1134346125
Name:MENDEZ, JACQUELINE NOEMY (LMFT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:NOEMY
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20201 ITASCA ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5415
Mailing Address - Country:US
Mailing Address - Phone:818-718-1355
Mailing Address - Fax:
Practice Address - Street 1:21201 VICTORY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2830
Practice Address - Country:US
Practice Address - Phone:818-804-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007302Medicaid
CAC4K0163OtherLA DMH PROVIDER
CACBSC331OtherLA DMH PROVIDER