Healthcare Provider Details

I. General information

NPI: 1114030764
Provider Name (Legal Business Name): JONATHAN MEYER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S BROADWAY SUITE 202
NYACK NY
10960-3834
US

IV. Provider business mailing address

53 S BROADWAY SUITE 202
NYACK NY
10960-3834
US

V. Phone/Fax

Practice location:
  • Phone: 845-596-1733
  • Fax: 845-359-0778
Mailing address:
  • Phone:
  • Fax: 845-359-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR037021-1
License Number StateNY

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: