Provider Demographics
NPI:1801564422
Name:MEZA, RICHARD CHRISTOPHER II (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHRISTOPHER
Last Name:MEZA
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 WALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2239
Mailing Address - Country:US
Mailing Address - Phone:909-904-0231
Mailing Address - Fax:
Practice Address - Street 1:16195 SISKIYOU RD STE 120B
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1346
Practice Address - Country:US
Practice Address - Phone:909-904-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty