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General NPI Number Information
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NPI Number | 1073625091
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Entity Type | Individual
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Provider Name | IDALIA G MENDOZA LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 4528 E INGLE RD
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City | EDINBURG
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State | TX
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Zip | 78541
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Country | US
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Telephone | 956-618-7107
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Fax | 956-618-7148
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Provider Business Mailing Address
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Address Line | 202 REBECCA DR
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City | EDINBURG
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State | TX
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Zip | 78542-0635
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23619
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S23619
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License Number State | TX
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