Healthcare Provider Details

I. General information

NPI: 1447737234
Provider Name (Legal Business Name): MEZA BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 EDGEMONT CRESCENT
WAYNE NJ
07470
US

IV. Provider business mailing address

40 EDGEMONT CRESCENT
WAYNE NJ
07470
US

V. Phone/Fax

Practice location:
  • Phone: 201-898-1115
  • Fax:
Mailing address:
  • Phone: 201-898-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number16213-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number355100446100
License Number StateNJ

VIII. Authorized Official

Name: DR. TEISSY MEZA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 201-898-1115