Healthcare Provider Details

I. General information

NPI: 1417090291
Provider Name (Legal Business Name): TEISSY MEZA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST DEPARTMENT-PEDIATRICS
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

32 LUPTON LN
HALEDON NJ
07508-1723
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number061-A295
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: