Healthcare Provider Details

I. General information

NPI: 1487456216
Provider Name (Legal Business Name): JENNIFER MEJIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER HALULA

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PASEO REYES DR
SAINT AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

90 VIA SONRISA
SAINT AUGUSTINE FL
32092-3128
US

V. Phone/Fax

Practice location:
  • Phone: 904-834-5927
  • Fax:
Mailing address:
  • Phone: 904-553-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: