Provider Demographics
NPI:1912985458
Name:MENDES, ANITA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:M
Last Name:MENDES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NH
Mailing Address - Zip Code:03449-0212
Mailing Address - Country:US
Mailing Address - Phone:603-525-3454
Mailing Address - Fax:603-525-3454
Practice Address - Street 1:174 CONCORD STREET
Practice Address - Street 2:160
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1222
Practice Address - Country:US
Practice Address - Phone:603-525-3454
Practice Address - Fax:603-525-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1040086OtherHCVM
NH412056751OtherHARVARD PILG/PACIFICARE
NH220649741OtherUNITED BEHAVIORAL HEALTH
NH458185OtherTUFTS HEALTH CARE
NH9R0183OtherEMPIRE BCBS
NH1405573Y0NH02OtherBLUE CROSS BLUE SHIELD
NH412056751OtherGREAT WEST
NH463366OtherVALUE OPTIONS
NH477489000OtherMEGELLAN
NH412056751-002OtherAETNA
NH03422476OtherTRI-CARE
NH1040886OtherCIGNA BEHAV. HEALTH CARE
NH213591OtherCOMPPSYCH
NH30422476Medicaid
NH412056751OtherUNITED BEHAVIORAL HEALTH
NH550010007027OtherPACIFICARE
NH463366OtherVALUE OPTIONS