Provider Demographics
NPI:1649576810
Name:TORNARITIS, MEREDITH ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:TORNARITIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:KIRSTEIN BUILDING OFFICE 251
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:615-661-3501
Mailing Address - Fax:617-667-7981
Practice Address - Street 1:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-3501
Practice Address - Fax:617-667-7981
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216470104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker