Provider Demographics
NPI:1881029767
Name:VALERIO MEJIA, INGRID NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:NICOLE
Last Name:VALERIO MEJIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1235 PENN AVE
Mailing Address - Street 2:SUITE 205-206
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2100
Mailing Address - Country:US
Mailing Address - Phone:610-374-4963
Mailing Address - Fax:610-378-5403
Practice Address - Street 1:1105 BERKSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1222
Practice Address - Country:US
Practice Address - Phone:610-374-4963
Practice Address - Fax:610-378-5403
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0241581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical