Provider Demographics
NPI:1164767216
Name:CANADA, MEREDITH L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:CANADA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11003
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-0003
Mailing Address - Country:US
Mailing Address - Phone:317-416-4926
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 88052
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-0052
Practice Address - Country:US
Practice Address - Phone:317-416-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007038A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical