MEDICARE: MARIA DEL CARMEN MENDEZ MARIN 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	SW22259	FL

General Provider Information

NPI Number	:	1730940503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DEL CARMEN MENDEZ MARIN LCSW

Provider Business Mailing Address
First Line	:	919 NE 13TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-2012
Country	:	US
Telephone Number	:	786-930-8806
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 NE 13TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-2009
Country	:	US
Telephone Number	:	954-763-2030
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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