Provider Demographics
NPI:1477082576
Name:MEREDITH, MARJORIE BRIGITTE (MSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:BRIGITTE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:BRIGITTE
Other - Last Name:PICARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1848 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1848 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2875
Practice Address - Country:US
Practice Address - Phone:954-885-9500
Practice Address - Fax:954-885-9444
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW133061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical