Provider Demographics
NPI:1649361841
Name:MENDLESON, DEBORAH FAITH (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:FAITH
Last Name:MENDLESON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-239-4563
Mailing Address - Fax:
Practice Address - Street 1:19 FRONT ST
Practice Address - Street 2:STE 204
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3795
Practice Address - Country:US
Practice Address - Phone:978-239-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10292081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
248108000OtherHARVARD PILGRIM
P07737OtherBCBS
107561OtherUBH