MEDICARE: MECCIA MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036086487	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	334545432	OTHER	IL	SS#
2	1851369482	OTHER	IL	NPI PERSONAL PROVIDER #

General Provider Information

NPI Number	:	1669574000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECCIA MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	930 N YORK RD
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-2991
Country	:	US
Telephone Number	:	630-789-5848
Fax Number	:	630-789-9251

Provider Business Practice Location Address
First Line	:	930 N YORK RD
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-2991
Country	:	US
Telephone Number	:	630-789-5848
Fax Number	:	630-789-9251

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	SALVATORE MECCIA
Credential	:	MD
Telephone Number	:	630-789-5848

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	01/16/2015

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