MEDICARE: INEZ MARIE MENDEZ ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	117835	CA
2	101Y00000X	Counselor
3	373H00000X	Day Training/Habilitation Specialist		CA
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	106S00000X	Behavior Technician		CA
6	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1043720899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INEZ MARIE MENDEZ ACSW

Provider Business Mailing Address
First Line	:	3433 W SHAW AVE STE 102
Second Line	:	2416 W SHAW STE 114
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-540-0614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 W SHAW AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-558-4051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	12/01/2025

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