Individual provider Active NPI

Christina Mendez, LCSW

  • Clinical Social Worker
  • Evanston, IL
National Provider Identifier
1174137400
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149019811 Issued in IL
Practice address
355 Ridge Ave FL 2
Evanston, IL 60202-3328
Phone
(847) 316-6262
NPI assigned
Sep 3, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149019811 IL Primary

Addresses

Primary practice location

355 Ridge Ave FL 2
Evanston, IL 60202-3328

Mailing address

1820 S 25TH Ave
Broadview, IL 60155-2864
Phone (847) 316-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210305000776 IL Practitioner - Clinical Social Worker 1951717545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1174137400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 S 25TH AVE",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601552864",
            "telephone_number": "847-316-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 RIDGE AVE FL 2",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023328",
            "telephone_number": "847-316-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDEZ",
        "first_name": "CHRISTINA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

Verify at the official NPI Registry.