Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 104343 | NY |
NPI | 1003395260 |
---|---|
Provider Name | Ms. Hayley Alexandra Mena |
First Address | Huntington Station, NY 11746-2841 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 27/12/2020 |