Provider Demographics
NPI:1588452510
Name:MEZA MCKENNIS, KARLA ZUNILDA (SW)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:ZUNILDA
Last Name:MEZA MCKENNIS
Suffix:
Gender:
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FANEUIL ST APT 160
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1909
Mailing Address - Country:US
Mailing Address - Phone:857-492-3150
Mailing Address - Fax:
Practice Address - Street 1:51 FANEUIL ST APT 160
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1909
Practice Address - Country:US
Practice Address - Phone:857-492-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227186104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker