Active NPI
Jeffrey P. Mendillo, LCSW
- Clinical Social Worker
- Conroe, TX
National Provider Identifier
1265026835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 65911
- Practice address
- 100 I-45 North
Suite 320
Conroe, TX 77301 - Phone
- (936) 701-0894
- NPI assigned
- Feb 24, 2021
- Reactivated
- Feb 7, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 65911 | TX | Primary |
Addresses
Primary practice location
100 I-45 North
Suite 320
Conroe, TX 77301
Mailing address
206A S Loop 336 W
Unit 312
Conroe, TX 77304
Phone (936) 701-0894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65911 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644192000000",
"number": "1265026835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206A S LOOP 336 W",
"address_2": "UNIT 312",
"city": "CONROE",
"state": "TX",
"postal_code": "77304",
"telephone_number": "936-701-0894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 I-45 NORTH",
"address_2": "SUITE 320",
"city": "CONROE",
"state": "TX",
"postal_code": "77301",
"telephone_number": "936-701-0894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDILLO",
"first_name": "JEFFREY",
"middle_name": "P.",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-24",
"last_updated": "2022-02-07",
"certification_date": "2022-02-07",
"deactivation_date": "2021-04-08",
"reactivation_date": "2022-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "65911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
- Chelsea Melear
- Amy K Mellonig, AUDIOLOGIST
- Jessette S Melon
- Memorial Hermann Health System
- Memorial Hermann Health System
- Mending Peace and Purpose Mental Health Services PLLC
- Mending Peace and Purpose Mental Health Services PLLC
- Mendocino Dialysis LLC
- Christopher Mendoza, MD
- Louise Nicolette Alcantara Mendoza
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.