Provider Demographics
NPI:1639263122
Name:BURNETT, MEREDITH POOL (LCSW MA ED)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:POOL
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LCSW MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WESTERN TERRACE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363
Mailing Address - Country:US
Mailing Address - Phone:484-885-8624
Mailing Address - Fax:610-932-7744
Practice Address - Street 1:330 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1233
Practice Address - Country:US
Practice Address - Phone:484-885-8624
Practice Address - Fax:610-932-7744
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014288101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-3086403OtherEIN (MEREDITHS BLOOMS)
PA084011Medicare ID - Type Unspecified