Healthcare Provider Details

I. General information

NPI: 1205428638
Provider Name (Legal Business Name): ELISAIDA MENDEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20525 CENTER RIDGE RD STE 403
ROCKY RIVER OH
44116-3401
US

IV. Provider business mailing address

20525 CENTER RIDGE RD STE 403
ROCKY RIVER OH
44116-3401
US

V. Phone/Fax

Practice location:
  • Phone: 866-466-9591
  • Fax:
Mailing address:
  • Phone: 866-466-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP7482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: