Healthcare Provider Details

I. General information

NPI: 1447355128
Provider Name (Legal Business Name): LILY ANN MENDOZA DIVINO LCSW, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13626 37TH AVE
FLUSHING NY
11354-6533
US

IV. Provider business mailing address

125 WALKER ST FL 2
NEW YORK NY
10013-4135
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-1222
  • Fax: 718-886-3903
Mailing address:
  • Phone: 212-226-8866
  • Fax: 212-226-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: