Provider Demographics
NPI:1538640354
Name:CANN, MEREDITH VITALE (LMSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:VITALE
Last Name:CANN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1812
Mailing Address - Country:US
Mailing Address - Phone:201-956-0482
Mailing Address - Fax:
Practice Address - Street 1:2778 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4029
Practice Address - Country:US
Practice Address - Phone:718-402-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker