MEDICARE: JUDITH MEKAMKWE

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	103TC2200X	Clinical Child & Adolescent Psychologist	1650822221	NY

General Provider Information

NPI Number	:	1871216986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH MEKAMKWE

Provider Business Mailing Address
First Line	:	2738 FENTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5517
Country	:	US
Telephone Number	:	917-495-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2738 FENTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5517
Country	:	US
Telephone Number	:	917-495-1491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	09/22/2022

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