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General NPI Number Information
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NPI Number | 1780956979
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Entity Type | Individual
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Provider Name | KRISTEN C MEEHAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 130 E SPENCER ST
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City | ITHACA
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State | NY
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Zip | 14850-5608
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Country | US
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Telephone | 607-258-6956
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Fax | 833-523-2396
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Provider Business Mailing Address
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Address Line | 407 COLLEGE AVENUE, #517 SUITE #2
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City | ITHACA
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State | NY
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Zip | 14850-5474
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Country | US
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Telephone | 607-258-6956
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Fax | 833-523-2396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 081237
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License Number State | NY
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