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General NPI Number Information
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NPI Number | 1306421243
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Entity Type | Individual
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Provider Name | ANTHONY MICHAEL MEZA CSW
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Gender | Male
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 713 MILLPOND RD STE B3
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City | LEXINGTON
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State | KY
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Zip | 40514-1571
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Country | US
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Telephone | 859-309-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 1649 OLD LEESTOWN RD
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City | LEXINGTON
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State | KY
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Zip | 40511-2083
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Country | US
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Telephone | 909-238-5620
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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 | 254843
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License Number State | KY
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