Provider Demographics
NPI:1013419852
Name:LIVINGSTON-MEJIA, AMANDA (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LIVINGSTON-MEJIA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 942056
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-2056
Mailing Address - Country:US
Mailing Address - Phone:805-410-3858
Mailing Address - Fax:
Practice Address - Street 1:299 W HILLCREST DR STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7824
Practice Address - Country:US
Practice Address - Phone:805-410-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6758Medicaid
CA7068Medicaid
CA7420Medicaid