Healthcare Provider Details

I. General information

NPI: 1437741162
Provider Name (Legal Business Name): ADELAIDA KELLY MEJIA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 5TH AVE STE 822
NEW YORK NY
10010-7765
US

IV. Provider business mailing address

1702 2ND AVE APT 2A
NEW YORK NY
10128-3277
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-1697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP139457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: