MEDICARE: MELISSA E. MENDOZA LMSW

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	6801091600	MI

General Provider Information

NPI Number	:	1326441064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E. MENDOZA LMSW

Provider Business Mailing Address
First Line	:	25600 WOODWARD AVE STE 100
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-0944
Country	:	US
Telephone Number	:	833-746-5779
Fax Number	:	833-233-3547

Provider Business Practice Location Address
First Line	:	25600 WOODWARD AVE STE 100
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-0944
Country	:	US
Telephone Number	:	833-746-5779
Fax Number	:	833-233-3547

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

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	07/03/2020

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