Provider Demographics
NPI:1164289997
Name:DEAN, MEREDITH ELANA (LCAT, ICDAC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ELANA
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCAT, ICDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 5TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4012
Mailing Address - Country:US
Mailing Address - Phone:917-856-2473
Mailing Address - Fax:
Practice Address - Street 1:425 5TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4012
Practice Address - Country:US
Practice Address - Phone:917-856-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001354-1101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist