Healthcare Provider Details

I. General information

NPI: 1578107579
Provider Name (Legal Business Name): MEREDITH ELISE FREEMAN-WU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3652
US

IV. Provider business mailing address

16 ASTOR PL
GLEN RIDGE NJ
07028-2021
US

V. Phone/Fax

Practice location:
  • Phone: 973-866-5435
  • Fax:
Mailing address:
  • Phone: 973-615-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06180100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: