MEDICARE: MONICA MARIE MEJIA-HANNAMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	101825	TX

General Provider Information

NPI Number	:	1205274172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MARIE MEJIA-HANNAMAN

Provider Business Mailing Address
First Line	:	206 ORCHARD DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9325
Country	:	US
Telephone Number	:	562-743-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 ORCHARD DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9325
Country	:	US
Telephone Number	:	562-743-0806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	08/11/2024

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