Healthcare Provider Details

I. General information

NPI: 1306374947
Provider Name (Legal Business Name): EDWIN MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
TAUNTON MA
02780-5293
US

IV. Provider business mailing address

8 SHORT ST
ATTLEBORO MA
02703-4912
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-9116
  • Fax: 508-828-9146
Mailing address:
  • Phone: 310-612-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11985
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11985
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: