Provider Demographics
NPI:1811207129
Name:MEZA, LINA CLAIRE (MPS,ATR-BC,LCAT,CCLS)
Entity Type:Individual
Prefix:MS
First Name:LINA
Middle Name:CLAIRE
Last Name:MEZA
Suffix:
Gender:F
Credentials:MPS,ATR-BC,LCAT,CCLS
Other - Prefix:MRS
Other - First Name:LINA
Other - Middle Name:CLAIRE
Other - Last Name:MEZA-MURILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPS,ATR-BC,LCAT,CCLS
Mailing Address - Street 1:360 UNION STREET
Mailing Address - Street 2:A2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4948
Mailing Address - Country:US
Mailing Address - Phone:917-596-8517
Mailing Address - Fax:
Practice Address - Street 1:190 NORTH 10TH STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9317
Practice Address - Country:US
Practice Address - Phone:917-596-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001181221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist