Provider Demographics
NPI:1609960384
Name:MESIANO, ANTHONY J JR (LISW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:MESIANO
Suffix:JR
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 JEREME BAY RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170
Mailing Address - Country:US
Mailing Address - Phone:803-234-2928
Mailing Address - Fax:803-905-5653
Practice Address - Street 1:1415 BLANDING ST
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2922
Practice Address - Country:US
Practice Address - Phone:803-779-7500
Practice Address - Fax:803-779-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5729104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ322846386Medicare ID - Type Unspecified
SCQ32284Medicare UPIN