Provider Demographics
NPI:1093251803
Name:BRANDOW, MEAGHAN (MA)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:BRANDOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE B PMB188
Mailing Address - City:GRAND HAVE
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 WEST 24TH ST
Practice Address - Street 2:SUITE B PMB188
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:231-683-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional