Healthcare Provider Details

I. General information

NPI: 1114594496
Provider Name (Legal Business Name): LAILA MEJIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAXI CT
STATEN ISLAND NY
10304-5201
US

IV. Provider business mailing address

16 MAXI CT
STATEN ISLAND NY
10304-5201
US

V. Phone/Fax

Practice location:
  • Phone: 917-670-3521
  • Fax:
Mailing address:
  • Phone: 917-670-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111987-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: