MEDICARE: LUIS MENDEZ 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
1	1041C0700X	Clinical Social Worker	007425	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164615068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS MENDEZ LCSW

Provider Business Mailing Address
First Line	:	175 ADDISON RD STE 104
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-2178
Country	:	US
Telephone Number	:	860-513-2327
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 ADDISON RD STE 104
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-2178
Country	:	US
Telephone Number	:	860-513-2327
Fax Number	:

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

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	10/17/2024

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Directions to “ LUIS MENDEZ LCSW” Practice Location

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