Provider Demographics
NPI:1003967878
Name:MEYERSON, JOANNE (MARRIAGE AND FAMILY)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:MEYERSON
Suffix:
Gender:F
Credentials:MARRIAGE AND FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 QUAIL STREET
Mailing Address - Street 2:# 235
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2730
Mailing Address - Country:US
Mailing Address - Phone:949-552-6767
Mailing Address - Fax:949-559-4909
Practice Address - Street 1:1400 QUAIL STREET
Practice Address - Street 2:# 235
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2730
Practice Address - Country:US
Practice Address - Phone:949-559-6600
Practice Address - Fax:949-559-4909
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist