Healthcare Provider Details

I. General information

NPI: 1679492060
Provider Name (Legal Business Name): THANIA E MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 142942
ARECIBO PR
00614-2942
US

IV. Provider business mailing address

PO BOX 142942
ARECIBO PR
00614-2942
US

V. Phone/Fax

Practice location:
  • Phone: 939-334-1976
  • Fax:
Mailing address:
  • Phone: 939-238-2709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7981
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: