Provider Demographics
NPI:1750094413
Name:MENDOZA, MAYRA E (LCSW)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:E
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22192
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-2192
Mailing Address - Country:US
Mailing Address - Phone:831-710-0783
Mailing Address - Fax:
Practice Address - Street 1:402 W BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3554
Practice Address - Country:US
Practice Address - Phone:866-478-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126746104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker