Provider Demographics
NPI:1982046629
Name:MENDOLA, MATTHEW LOENARD
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LOENARD
Last Name:MENDOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1436
Mailing Address - Country:US
Mailing Address - Phone:917-685-1950
Mailing Address - Fax:
Practice Address - Street 1:600 LAFAYETTE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1020
Practice Address - Country:US
Practice Address - Phone:718-483-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health