Healthcare Provider Details

I. General information

NPI: 1548632235
Provider Name (Legal Business Name): GERLANY MEJIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FRUIT HILL AVE
NORTH PROVIDENCE RI
02911-2626
US

IV. Provider business mailing address

420 FRUIT HILL AVE
NORTH PROVIDENCE RI
02911-2626
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-3900
  • Fax:
Mailing address:
  • Phone: 401-699-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01807
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: