Provider Demographics
NPI:1174655989
Name:CANHAM-NELSON, MERIDETH ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MERIDETH
Middle Name:ANN
Last Name:CANHAM-NELSON
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-0646
Mailing Address - Country:US
Mailing Address - Phone:831-915-3664
Mailing Address - Fax:
Practice Address - Street 1:126E BONIFACIO PL
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2713
Practice Address - Country:US
Practice Address - Phone:831-915-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 20082104100000X
CALCSW200821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker