Provider Demographics
NPI:1447519889
Name:MENDOZA, KATHARINE W (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:W
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4271
Mailing Address - Country:US
Mailing Address - Phone:407-247-5972
Mailing Address - Fax:407-332-6226
Practice Address - Street 1:1385 W STATE ROAD 434
Practice Address - Street 2:SUITE 207
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6871
Practice Address - Country:US
Practice Address - Phone:407-247-5972
Practice Address - Fax:407-332-6226
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW64871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical