Provider Demographics
NPI:1023389806
Name:HARLOW, MEREDITH HUGHES (LCSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:HUGHES
Last Name:HARLOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 AC SKINNER PARKWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:5742 BOOTH RD
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5982
Practice Address - Country:US
Practice Address - Phone:904-739-7779
Practice Address - Fax:904-739-7771
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 106251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ04KEOtherBC/BS
FLGH538ZMedicare PIN
FLGH538VMedicare PIN
FLGH538YMedicare PIN
FLGH538WMedicare PIN
FLZ04KEOtherBC/BS