Provider Demographics
NPI:1295220622
Name:MONI-MEJIA, JOHANNA I
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:MONI-MEJIA
Suffix:I
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 1:284 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3682
Mailing Address - Country:US
Mailing Address - Phone:617-697-3597
Mailing Address - Fax:
Practice Address - Street 1:43 CHUBB RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7804
Practice Address - Country:US
Practice Address - Phone:508-302-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician