Provider Demographics
NPI:1205177359
Name:MENDOZA-BURCHAM, MARISSA IMEE (PHD, NCSP)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:IMEE
Last Name:MENDOZA-BURCHAM
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BINGHAM ST
Mailing Address - Street 2:FRANKLIN BLDG., 1ST FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1101
Mailing Address - Country:US
Mailing Address - Phone:412-235-5445
Mailing Address - Fax:
Practice Address - Street 1:1011 BINGHAM ST
Practice Address - Street 2:FRANKLIN BLDG., 1ST FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1101
Practice Address - Country:US
Practice Address - Phone:412-235-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool