Healthcare Provider Details

I. General information

NPI: 1326812744
Provider Name (Legal Business Name): KATHERINE MEOLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 WESTCHESTER AVE
BRONX NY
10461-3585
US

IV. Provider business mailing address

45 BURNT HILL RD
SKILLMAN NJ
08558-2107
US

V. Phone/Fax

Practice location:
  • Phone: 855-681-8700
  • Fax:
Mailing address:
  • Phone: 908-619-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06694500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: