Healthcare Provider Details

I. General information

NPI: 1508308511
Provider Name (Legal Business Name): MARCELA MEJIA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 E COMMERCIAL BLVD STE 405
FORT LAUDERDALE FL
33308-4029
US

IV. Provider business mailing address

906 N 13TH TER
HOLLYWOOD FL
33019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 754-400-5514
  • Fax:
Mailing address:
  • Phone: 561-306-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: