MEDICARE: LUIS MENDEZ, LCSW, LLC

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

General Provider Information

NPI Number	:	1487012696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUIS MENDEZ, LCSW, LLC

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	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	LUIS MENDEZ
Credential	:	LCSW
Telephone Number	:	860-513-2327

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	10/17/2024

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