Provider Demographics
NPI:1225668650
Name:MERIDIAN PSYCHOTHERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MERIDIAN PSYCHOTHERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-988-6900
Mailing Address - Street 1:PO BOX 3023
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-3023
Mailing Address - Country:US
Mailing Address - Phone:203-988-6900
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1639
Practice Address - Country:US
Practice Address - Phone:203-988-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN PSYCHOTHERAPY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-24
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty