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General NPI Number Information
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NPI Number | 1528109733
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Entity Type | Individual
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Provider Name | MARY L MENDES LCSW, CEAP
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Gender | Female
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 496 SMITHTOWN BYP SUITE 202
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City | SMITHTOWN
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State | NY
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Zip | 11787-5005
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Country | US
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Telephone | 407-408-3254
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Fax | 631-750-5263
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Provider Business Mailing Address
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Address Line | 113 RAILROAD AVE #9
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City | SAYVILLE
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State | NY
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Zip | 11782-2703
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Country | US
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Telephone | 407-408-3254
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Fax | 631-750-5263
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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 | 73-080801
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License Number State | NY
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