Provider Demographics
NPI:1134788334
Name:MENDOZA, MELISSA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:MENDOZA
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 1:15 PASEO DE SAN ANTONIO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3746
Mailing Address - Country:US
Mailing Address - Phone:505-231-8578
Mailing Address - Fax:
Practice Address - Street 1:15 PASEO DE SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3746
Practice Address - Country:US
Practice Address - Phone:505-231-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-095071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical