Provider Demographics
NPI:1396561585
Name:MENDEZ, ALEXANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4008 BOBWHITE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4890
Mailing Address - Country:US
Mailing Address - Phone:208-901-9168
Mailing Address - Fax:
Practice Address - Street 1:2005 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4808
Practice Address - Country:US
Practice Address - Phone:208-323-9600
Practice Address - Fax:208-466-5359
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker