Healthcare Provider Details

I. General information

NPI: 1750158275
Provider Name (Legal Business Name): LESLIE R MEJIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 CANAL PL STUDIO 212
BRONX NY
10451
US

IV. Provider business mailing address

1081 CRANBROOK RD
UNION NJ
07083-6328
US

V. Phone/Fax

Practice location:
  • Phone: 917-887-7852
  • Fax:
Mailing address:
  • Phone: 917-887-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: