MEDICARE: VERONICA MENDEZ LCSW, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001496	CO
2	1041C0700X	Clinical Social Worker	CSW.09926746	CO

General Provider Information

NPI Number	:	1265962211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA MENDEZ LCSW, LAC

Provider Business Mailing Address
First Line	:	1008 PATTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524
Country	:	US
Telephone Number	:	970-494-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 PATTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8052
Country	:	US
Telephone Number	:	970-494-4200
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	07/21/2022

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