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General NPI Number Information
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NPI Number | 1134648876
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Entity Type | Individual
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Provider Name | TYLER MENDOZA LMHC
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Gender | Male
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 347 5TH AVE RM 703A
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City | NEW YORK
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State | NY
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Zip | 10016-5036
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Country | US
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Telephone | 646-425-1936
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Fax | 646-578-8292
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Provider Business Mailing Address
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Address Line | 347 5TH AVE RM 703A
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City | NEW YORK
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State | NY
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Zip | 10016-5036
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Country | US
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Telephone | 646-425-1936
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Fax | 646-578-8292
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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