Healthcare Provider Details

I. General information

NPI: 1972642825
Provider Name (Legal Business Name): MEREDITH ANNA BALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E LIVE OAK AVE
ARCADIA CA
91006-5617
US

IV. Provider business mailing address

1175 W BASELINE RD
CLAREMONT CA
91711
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-5858
  • Fax:
Mailing address:
  • Phone: 909-437-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: