Provider Demographics
NPI:1528109733
Name:MENDES, MARY L (LCSW, CEAP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:MENDES
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Gender:F
Credentials:LCSW, CEAP
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Mailing Address - Street 1:113 RAILROAD AVE
Mailing Address - Street 2:#9
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2703
Mailing Address - Country:US
Mailing Address - Phone:407-408-3254
Mailing Address - Fax:631-750-5263
Practice Address - Street 1:496 SMITHTOWN BYP
Practice Address - Street 2:SUITE 202
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:407-408-3254
Practice Address - Fax:631-750-5263
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY73-0808011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical