Provider Demographics
NPI:1043042658
Name:MEJIA VARGAS, SUSANA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:MEJIA VARGAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 OCEAN LANE DR APT 800
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1476
Mailing Address - Country:US
Mailing Address - Phone:305-733-1775
Mailing Address - Fax:
Practice Address - Street 1:155 OCEAN LANE DR APT 800
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1476
Practice Address - Country:US
Practice Address - Phone:305-733-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW228891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty