Provider Demographics
NPI:1205267127
Name:MENDIOLA, JUDITH (MA;CT;C-HCLC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:MA;CT;C-HCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 FEATHER ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8029
Mailing Address - Country:US
Mailing Address - Phone:321-607-2779
Mailing Address - Fax:
Practice Address - Street 1:4410 FEATHER ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-8029
Practice Address - Country:US
Practice Address - Phone:321-607-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor