Healthcare Provider Details

I. General information

NPI: 1942690896
Provider Name (Legal Business Name): NANCY MENDOZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST SUITE A
MARINA CA
93933
US

IV. Provider business mailing address

1611 BUNKER HILL WAY STE 120
SALINAS CA
93906-6006
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax:
Mailing address:
  • Phone: 831-755-4545
  • Fax: 831-755-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number84306
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: