Healthcare Provider Details

I. General information

NPI: 1790482842
Provider Name (Legal Business Name): SHIREEN MENDOZA LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N GLEBE RD
ARLINGTON VA
22203-1853
US

IV. Provider business mailing address

901 N GLEBE RD
ARLINGTON VA
22203-1853
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax: 833-419-0181
Mailing address:
  • Phone: 323-205-7088
  • Fax: 833-419-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: