Provider Demographics
NPI:1205428638
Name:MENDEZ, ELISAIDA (PHD)
Entity type:Individual
Prefix:
First Name:ELISAIDA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD STE 403
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3401
Mailing Address - Country:US
Mailing Address - Phone:866-466-9591
Mailing Address - Fax:
Practice Address - Street 1:20525 CENTER RIDGE RD STE 403
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3401
Practice Address - Country:US
Practice Address - Phone:866-466-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP74821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical