Healthcare Provider Details

I. General information

NPI: 1881152544
Provider Name (Legal Business Name): YESSENIA ESTHER MEJIA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YESSENIA MEJIA CERVO PSYD

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-1712
  • Fax:
Mailing address:
  • Phone: 212-342-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number023033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: