Provider Demographics
NPI:1275263774
Name:TEJADA, MARIEL D
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:D
Last Name:TEJADA
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 1:3 W FARMS SQUARE PLZ APT 11B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2937
Mailing Address - Country:US
Mailing Address - Phone:917-257-3515
Mailing Address - Fax:
Practice Address - Street 1:3 W FARMS SQUARE PLZ APT 11B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2937
Practice Address - Country:US
Practice Address - Phone:917-257-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health