Healthcare Provider Details

I. General information

NPI: 1912877978
Provider Name (Legal Business Name): MARISSA GUADALUPE MENDOZA MALDONADO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 FARM TO MARKET 1960 RD E STE 117
HUMBLE TX
77346
US

IV. Provider business mailing address

8530 FARM TO MARKET 1960 RD E STE 117
HUMBLE TX
77346
US

V. Phone/Fax

Practice location:
  • Phone: 281-713-9004
  • Fax:
Mailing address:
  • Phone: 281-713-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117408
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: