Healthcare Provider Details

I. General information

NPI: 1992704829
Provider Name (Legal Business Name): ROBERT J MENDOZA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WASHINGTON ST #203
DEDHAM MA
02026-1870
US

IV. Provider business mailing address

339 WASHINGTON ST #203
DEDHAM MA
02026-1870
US

V. Phone/Fax

Practice location:
  • Phone: 617-953-9154
  • Fax:
Mailing address:
  • Phone: 617-953-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7275
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: