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NPI Code Detail

MEDICARE: MR. MANUEL L MENDEZ JR. LCSW

MEDICARE: MR. MANUEL L MENDEZ JR. LCSW
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
11041C0700XClinical Social Worker2011037275MO

General Provider Information

NPI Number : 1053746610
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MANUEL L MENDEZ JR. LCSW
Provider Business Mailing Address
First Line : 1800 COMMUNITY
Second Line :
City : CLINTON
State : MO
Zip : 64735-8804
Country : US
Telephone Number : 660-885-8131
Fax Number :
Provider Business Practice Location Address
First Line : 206 S MILL ST
Second Line :
City : ELDON
State : MO
Zip : 65026-1864
Country : US
Telephone Number : 573-392-1828
Fax Number : 573-392-1864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2013
Last Update Date : 03/26/2019

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