Healthcare Provider Details

I. General information

NPI: 1376236893
Provider Name (Legal Business Name): PATRICIA MEJIA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MOUNT AIRY RD STE 100
BASKING RIDGE NJ
07920-2338
US

IV. Provider business mailing address

722 ADAMS AVE
ELIZABETH NJ
07201-1633
US

V. Phone/Fax

Practice location:
  • Phone: 908-434-6008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00953800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: