Provider Demographics
NPI:1396367736
Name:MEZA VALENCIA, LAURA GENELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GENELLE
Last Name:MEZA VALENCIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 N FEDERAL HWY # 185
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6854
Mailing Address - Country:US
Mailing Address - Phone:561-465-4962
Mailing Address - Fax:
Practice Address - Street 1:ONE MIFFLIN PLACE
Practice Address - Street 2:SUITE 400
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4946
Practice Address - Country:US
Practice Address - Phone:561-465-4962
Practice Address - Fax:888-965-2499
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical