MEDICARE: MISS MICHELE MEEHAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW3269	FL

General Provider Information

NPI Number	:	1083741508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELE MEEHAN LCSW

Provider Business Mailing Address
First Line	:	1812 WEST DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33755-2243
Country	:	US
Telephone Number	:	727-512-0864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3347 S WEST SHORE BLVD
Second Line	:	SUITE 6
City	:	TAMPA
State	:	FL
Zip	:	33629-7600
Country	:	US
Telephone Number	:	813-805-9505
Fax Number	:	813-805-9505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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