Healthcare Provider Details

I. General information

NPI: 1043042658
Provider Name (Legal Business Name): SUSANA MEJIA VARGAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 OCEAN LANE DR APT 800
KEY BISCAYNE FL
33149-1476
US

IV. Provider business mailing address

155 OCEAN LANE DR APT 800
KEY BISCAYNE FL
33149-1476
US

V. Phone/Fax

Practice location:
  • Phone: 305-733-1775
  • Fax:
Mailing address:
  • Phone: 305-733-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: