MEDICARE: MEREDITH L GLIDDEN LCAT

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	101YM0800X	Mental Health Counselor	1634-1	NY

General Provider Information

NPI Number	:	1538500558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH L GLIDDEN LCAT

Provider Business Mailing Address
First Line	:	30 HAVEMEYER ST
Second Line	:	3A
City	:	BROOKLYN
State	:	NY
Zip	:	11211-2172
Country	:	US
Telephone Number	:	646-469-3547
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 HAVEMEYER ST
Second Line	:	3A
City	:	BROOKLYN
State	:	NY
Zip	:	11211-2172
Country	:	US
Telephone Number	:	646-469-3547
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	04/27/2015

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