Provider Demographics
NPI:1790868800
Name:MEIROWITZ, JUDITH SAMUELS (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:SAMUELS
Last Name:MEIROWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:MEIROWITZ
Other - Last Name:TISCHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:50 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1226
Mailing Address - Country:US
Mailing Address - Phone:617-965-9699
Mailing Address - Fax:617-965-9699
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 125
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-861-1818
Practice Address - Fax:781-861-2057
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA008921OtherVALUE OPTIONS
MAPO 3822OtherBLUECROSS/BLUE SHIELD
327746OtherMANAGED HEALTH CARE NETWO
MAPO 3822OtherBLUECROSS/BLUE SHIELD