Provider Demographics
NPI:1306421243
Name:MEZA, ANTHONY MICHAEL (CSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:MEZA
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 OLD LEESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2083
Mailing Address - Country:US
Mailing Address - Phone:909-238-5620
Mailing Address - Fax:
Practice Address - Street 1:713 MILLPOND RD STE B3
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1571
Practice Address - Country:US
Practice Address - Phone:859-309-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2548431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical