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NPI Code Detail

MEDICARE: ANITA H MENDOZA LCSW

MEDICARE: ANITA H MENDOZA 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 Worker6801065249MI

General Provider Information

NPI Number : 1528290301
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA H MENDOZA LCSW
Provider Business Mailing Address
First Line : 2500 HAMLIN DR
Second Line :
City : INKSTER
State : MI
Zip : 48141-2348
Country : US
Telephone Number : 313-561-5100
Fax Number : 313-565-0309
Provider Business Practice Location Address
First Line : 2500 HAMLIN DR
Second Line :
City : INKSTER
State : MI
Zip : 48141-2348
Country : US
Telephone Number : 313-561-5100
Fax Number : 313-565-0309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2009
Last Update Date : 08/19/2009

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Directions to “ ANITA H MENDOZA LCSW” Practice Location

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