Healthcare Provider Details

I. General information

NPI: 1639198112
Provider Name (Legal Business Name): JUDITH MEZEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 SW 72ND ST SUITE 203
MIAMI FL
33173-3275
US

IV. Provider business mailing address

9260 SW 72ND ST SUITE 203
MIAMI FL
33173-3275
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-2318
  • Fax: 305-279-5540
Mailing address:
  • Phone: 305-275-2318
  • Fax: 305-279-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW3311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: