Healthcare Provider Details

I. General information

NPI: 1518782184
Provider Name (Legal Business Name): MANUELA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 PARKER AVE
WEST PALM BEACH FL
33405-2507
US

IV. Provider business mailing address

1400 NW 13TH ST APT 19
BOCA RATON FL
33486-2171
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-1222
  • Fax:
Mailing address:
  • Phone: 561-929-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW18966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: