Provider Demographics
NPI:1669574000
Name:MECCIA MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MECCIA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MECCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-789-5848
Mailing Address - Street 1:930 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2991
Mailing Address - Country:US
Mailing Address - Phone:630-789-5848
Mailing Address - Fax:630-789-9251
Practice Address - Street 1:930 N YORK RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2991
Practice Address - Country:US
Practice Address - Phone:630-789-5848
Practice Address - Fax:630-789-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360864872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL334545432OtherSS#
IL1851369482OtherNPI PERSONAL PROVIDER #
IL334545432OtherSS#