Provider Demographics
NPI:1700604899
Name:MENDOZA, BRENDA ANTONELLA (MSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANTONELLA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10822 LANTERN VIEW DR APT 307
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4204
Mailing Address - Country:US
Mailing Address - Phone:317-515-1203
Mailing Address - Fax:
Practice Address - Street 1:9780 LANTERN RD STE 350
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4093
Practice Address - Country:US
Practice Address - Phone:317-520-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical