Provider Demographics
NPI:1467550517
Name:MENEREY, NOAH JASON (LMSW)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:JASON
Last Name:MENEREY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E BELTLINE AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7673
Mailing Address - Country:US
Mailing Address - Phone:616-957-9112
Mailing Address - Fax:616-957-2409
Practice Address - Street 1:2025 E BELTLINE AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7673
Practice Address - Country:US
Practice Address - Phone:616-957-9112
Practice Address - Fax:616-957-2409
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800D162220OtherBC/BS
MIQ47501Medicare UPIN
MI800D162220OtherBC/BS