Healthcare Provider Details
I. General information
NPI: 1912985458
Provider Name (Legal Business Name): ANITA M MENDES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 01/05/2006
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
174 CONCORD STREET 160
PETERBOROUGH NH
03458-1222
US
IV. Provider business mailing address
PO BOX 212
HANCOCK NH
03449-0212
US
V. Phone/Fax
- Phone: 603-525-3454
- Fax: 603-525-3454
- Phone: 603-525-3454
- Fax: 603-525-3454
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 464 |
| License Number State | NH |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1040086 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | HCVM |
| # 2 | |
| Identifier | 412056751 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | HARVARD PILG/PACIFICARE |
| # 3 | |
| Identifier | 220649741 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | UNITED BEHAVIORAL HEALTH |
| # 4 | |
| Identifier | 458185 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | TUFTS HEALTH CARE |
| # 5 | |
| Identifier | 9R0183 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | EMPIRE BCBS |
| # 6 | |
| Identifier | 1405573Y0NH02 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | BLUE CROSS BLUE SHIELD |
| # 7 | |
| Identifier | 412056751 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | GREAT WEST |
| # 8 | |
| Identifier | 463366 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | VALUE OPTIONS |
| # 9 | |
| Identifier | 477489000 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | MEGELLAN |
| # 10 | |
| Identifier | 412056751-002 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | AETNA |
| # 11 | |
| Identifier | 03422476 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | TRI-CARE |
| # 12 | |
| Identifier | 1040886 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | CIGNA BEHAV. HEALTH CARE |
| # 13 | |
| Identifier | 213591 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | COMPPSYCH |
| # 14 | |
| Identifier | 30422476 |
| Identifier Type | MEDICAID |
| Identifier State | NH |
| Identifier Issuer | |
| # 15 | |
| Identifier | 412056751 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | UNITED BEHAVIORAL HEALTH |
| # 16 | |
| Identifier | 550010007027 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | PACIFICARE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
