Healthcare Provider Details

I. General information

NPI: 1669612982
Provider Name (Legal Business Name): MEREDITH MELVIN-COSGROVE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 WYOMING AVE
WEST PITTSTON PA
18643-2839
US

IV. Provider business mailing address

597 WYOMING AVE
WYOMING PA
18644-1806
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW125475
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: