Provider Demographics
NPI:1881176725
Name:MENDOZA, CASSANDRA MARIE (BT)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:BT
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:MARIE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1551 CASTLEPL SE
Mailing Address - Street 2:B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116
Mailing Address - Country:US
Mailing Address - Phone:801-648-5269
Mailing Address - Fax:
Practice Address - Street 1:1551 CASTLEPL SE
Practice Address - Street 2:B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87116
Practice Address - Country:US
Practice Address - Phone:801-648-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1546681366OtherTRICARE