Provider Demographics
NPI:1508308511
Name:MEJIA, MARCELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 N 13TH TER
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-3112
Mailing Address - Country:US
Mailing Address - Phone:561-306-0330
Mailing Address - Fax:
Practice Address - Street 1:2425 E COMMERCIAL BLVD STE 405
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4029
Practice Address - Country:US
Practice Address - Phone:754-400-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical