Most Relevant Information
Provider Data
| NPI Number: | 1003474511 |
| Provider Name: | JAQUANA MENDEZ CASAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/30/2019 |
| Last Updated: | 05/30/2019 |
Provider Practice Location
1575 WASHINGTON ST
WATERTOWN
NY
136019371
Practice Location Phone/Fax
| Phone: | 3157795060 |
| Fax: | 3157795028 |
Provider Mailing Location
1575 WASHINGTON ST
WATERTOWN
NY
136019371
Provider Mailing Phone/Fax
| Phone: | 3157795060 |
| Fax: | 3157795028 |