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General NPI Number Information
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NPI Number | 1003395260
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Entity Type | Individual
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Provider Name | HAYLEY ALEXANDRA MENA LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 101 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 516-761-4107
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Fax |
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Provider Business Mailing Address
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Address Line | 33 BOLAN DR
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-2841
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Country | US
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Telephone | 631-747-1044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 094377-01
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License Number State | NY
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