Provider Demographics
NPI:1265863369
Name:MEJIAS, MARIEMMA
Entity Type:Individual
Prefix:MRS
First Name:MARIEMMA
Middle Name:
Last Name:MEJIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CALLE FIDALGO DIAZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3850
Mailing Address - Country:US
Mailing Address - Phone:787-462-7519
Mailing Address - Fax:
Practice Address - Street 1:408 CALLE FIDALGO DIAZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3850
Practice Address - Country:US
Practice Address - Phone:787-462-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-28
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4020101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist