Healthcare Provider Details

I. General information

NPI: 1043288038
Provider Name (Legal Business Name): ELIZABETH H MEADOWS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date: 05/27/2011
Reactivation Date: 04/30/2019

III. Provider practice location address

146 PARADISE ROAD
BETHEL ME
04217
US

IV. Provider business mailing address

P.O. BOX 1114
BETHEL ME
04217
US

V. Phone/Fax

Practice location:
  • Phone: 704-575-1138
  • Fax:
Mailing address:
  • Phone: 704-575-1138
  • Fax: 414-456-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number453
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number373
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16454
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: