Provider Demographics
NPI:1851401657
Name:BURNESS, MERIDETH ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MERIDETH
Middle Name:ANN
Last Name:BURNESS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MERIDETH
Other - Middle Name:ANN
Other - Last Name:LOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4744 41ST AVE SW
Mailing Address - Street 2:SUITE 317
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116
Mailing Address - Country:US
Mailing Address - Phone:206-389-1265
Mailing Address - Fax:206-938-1234
Practice Address - Street 1:4744 41ST AVE SW
Practice Address - Street 2:SUITE 317
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-389-1265
Practice Address - Fax:206-938-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW45341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120885Medicare PIN