Provider Demographics
NPI:1871891788
Name:MENDEZ, RENAE T (LCSW)
Entity type:Individual
Prefix:MS
First Name:RENAE
Middle Name:T
Last Name:MENDEZ
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 1:4002 NIBLICK CT
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2242
Mailing Address - Country:US
Mailing Address - Phone:808-286-5688
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1471
Practice Address - Country:US
Practice Address - Phone:872-216-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0229951041C0700X
HILCSW-36221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical