Provider Demographics
NPI:1053034066
Name:MENDOZA, JESSELIN N (LCSW)
Entity type:Individual
Prefix:
First Name:JESSELIN
Middle Name:N
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSELIN
Other - Middle Name:AYSON
Other - Last Name:NARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1724 QUAIL PATH
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6812
Mailing Address - Country:US
Mailing Address - Phone:510-277-5178
Mailing Address - Fax:
Practice Address - Street 1:1724 QUAIL PATH
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6812
Practice Address - Country:US
Practice Address - Phone:510-277-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW203811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical