Provider Demographics
NPI:1184913154
Name:MENDEL, MARISA (MD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:MENDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WELLS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3320
Mailing Address - Country:US
Mailing Address - Phone:781-472-1477
Mailing Address - Fax:412-753-7640
Practice Address - Street 1:199 WELLS AVE STE 102
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-3320
Practice Address - Country:US
Practice Address - Phone:781-472-1477
Practice Address - Fax:412-753-7640
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3307642084P0800X, 2084P0804X
MA2589962084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry