MEDICARE: COURTNEY MENDES

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	103K00000X	Behavior Analyst	BH003047	PA

General Provider Information

NPI Number	:	1891144960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MENDES

Provider Business Mailing Address
First Line	:	3249 EMERALD ST
Second Line	:	1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2539
Country	:	US
Telephone Number	:	508-415-3802
Fax Number	:

Provider Business Practice Location Address
First Line	:	3249 EMERALD ST
Second Line	:	1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2539
Country	:	US
Telephone Number	:	508-415-3802
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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Directions to “ COURTNEY MENDES ” Practice Location

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