Healthcare Provider Details

I. General information

NPI: 1275422156
Provider Name (Legal Business Name): SIOBHAN MEJIA LP-MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 60TH ST RM 704
NEW YORK NY
10022-1799
US

IV. Provider business mailing address

110 E 60TH ST RM 704
NEW YORK NY
10022-1799
US

V. Phone/Fax

Practice location:
  • Phone: 347-533-0422
  • Fax:
Mailing address:
  • Phone: 631-323-6546
  • Fax: 631-850-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP010753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: