Provider Demographics
NPI:1821423179
Name:MEGUIN, ANNA IRENE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:IRENE
Last Name:MEGUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 GREENE COUNTY OFFICE BLDG
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-2868
Mailing Address - Country:US
Mailing Address - Phone:518-622-9163
Mailing Address - Fax:518-621-4228
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1363
Practice Address - Country:US
Practice Address - Phone:518-943-3619
Practice Address - Fax:518-943-3779
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY117601-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473230Medicaid