Provider Demographics
NPI:1437627775
Name:HETHERINGTON, MEAGHAN JOHNSON
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:JOHNSON
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 THOMASINA LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5235
Mailing Address - Country:US
Mailing Address - Phone:212-920-5466
Mailing Address - Fax:
Practice Address - Street 1:115 W 27TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6217
Practice Address - Country:US
Practice Address - Phone:212-627-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical