Healthcare Provider Details

I. General information

NPI: 1265964365
Provider Name (Legal Business Name): JUANITA ANN MEADLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

IV. Provider business mailing address

5101 SW 60TH STREET RD APT 605
OCALA FL
34474-5787
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-5555
  • Fax: 352-291-5409
Mailing address:
  • Phone: 561-983-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: