Provider Demographics
NPI:1336890763
Name:MENDEZ AGUILAR, MAKIA A (LSW)
Entity Type:Individual
Prefix:
First Name:MAKIA
Middle Name:A
Last Name:MENDEZ AGUILAR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MAKIA
Other - Middle Name:
Other - Last Name:SIDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:841 STEUBENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2301
Mailing Address - Country:US
Mailing Address - Phone:855-692-7247
Mailing Address - Fax:855-692-7247
Practice Address - Street 1:841 STEUBENVILLE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2301
Practice Address - Country:US
Practice Address - Phone:855-692-7247
Practice Address - Fax:855-692-7247
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2207662104100000X, 1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator