Healthcare Provider Details

I. General information

NPI: 1740604271
Provider Name (Legal Business Name): JOHAN ENRIQUE MEJIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HEMPSTEAD TPKE
WEST HEMPSTEAD NY
11552-1095
US

IV. Provider business mailing address

184 SPRUCEWOOD DR
LEVITTOWN NY
11756-3838
US

V. Phone/Fax

Practice location:
  • Phone: 516-481-2890
  • Fax:
Mailing address:
  • Phone: 917-977-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: