Provider Demographics
NPI:1689901308
Name:MECIAS, ANNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:MECIAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 SW 185TH WAY
Mailing Address - Street 2:
Mailing Address - City:SW RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1401
Mailing Address - Country:US
Mailing Address - Phone:754-204-6449
Mailing Address - Fax:
Practice Address - Street 1:8900 SW 168TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4569
Practice Address - Country:US
Practice Address - Phone:754-204-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMFT2424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMFT2424OtherSTATE LICENSE