Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1093229775 |
---|---|
Provider Name | Maira Jocelyn Mendoza |
First Address | Piscataway, NJ 08854-8021 |
Second Address | Newark, NJ 07103-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2017 |
Last Update Date | 17/11/2017 |