Provider Demographics
NPI:1366879611
Name:MENDEZ-VIGNE, LOUISA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LOUISA
Middle Name:
Last Name:MENDEZ-VIGNE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3919
Mailing Address - Country:US
Mailing Address - Phone:718-975-6688
Mailing Address - Fax:
Practice Address - Street 1:1619 E 54TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3919
Practice Address - Country:US
Practice Address - Phone:917-975-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355031103TS0200X
NY001459-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool