Provider Demographics
NPI:1831146729
Name:MENEELY, DAVID R (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:MENEELY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506-8698
Mailing Address - Country:US
Mailing Address - Phone:610-488-0593
Mailing Address - Fax:610-488-0598
Practice Address - Street 1:311 WOLF CREEK RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8698
Practice Address - Country:US
Practice Address - Phone:610-488-0593
Practice Address - Fax:610-488-0598
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0128421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR07847Medicare UPIN