Provider Demographics
NPI:1417282120
Name:MEJIA, IMELDA (LCSW)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 S BROADWAY
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-4501
Mailing Address - Country:US
Mailing Address - Phone:213-763-3164
Mailing Address - Fax:213-742-7011
Practice Address - Street 1:1933 S BROADWAY
Practice Address - Street 2:FLOOR 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:213-763-3164
Practice Address - Fax:213-742-7011
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW816291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical