Provider Demographics
NPI:1811657331
Name:TECKIE, MEBRAT LIDIA
Entity type:Individual
Prefix:
First Name:MEBRAT
Middle Name:LIDIA
Last Name:TECKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S ABEL ST APT 328
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-9043
Mailing Address - Country:US
Mailing Address - Phone:408-421-9899
Mailing Address - Fax:
Practice Address - Street 1:1102 S ABEL ST APT 328
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-9043
Practice Address - Country:US
Practice Address - Phone:408-421-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1038241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical