Provider Demographics
NPI:1831596063
Name:MENDOZA, NICHOLAS B (LCSW)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:B
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 MAGNOLIA AVE # A
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3245
Mailing Address - Country:US
Mailing Address - Phone:530-828-7171
Mailing Address - Fax:
Practice Address - Street 1:845 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2002
Practice Address - Country:US
Practice Address - Phone:530-896-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1177241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical