=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912470576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABINA J MENDOZA LICSW, MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2019
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6301 ORCHARD ST STE 3
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68505-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-309-3005
-----------------------------------------------------
Fax | 402-520-6610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8233 MACKENZIE RD
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68505-2068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-570-0401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2120
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 11731
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------