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General NPI Number Information
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NPI Number | 1356558688
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Entity Type | Individual
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Provider Name | JAIME MENDEZ LICSW
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 830 CHALKSTONE AVE TRAILER 36
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City | PROVIDENCE
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State | RI
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Zip | 02908-4734
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Country | US
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Telephone | 401-640-3917
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Fax | 401-525-2557
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Provider Business Mailing Address
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Address Line | 24 ANNETTE AVE
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City | PAWTUCKET
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State | RI
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Zip | 02861-4418
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Country | US
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Telephone | 401-640-3917
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Fax | 401-525-2557
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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 | ISW02030
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License Number State | RI
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