Provider Demographics
NPI:1851791016
Name:AVERY-MCDONALD, MEREDITH RAE (LCS W)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:RAE
Last Name:AVERY-MCDONALD
Suffix:
Gender:F
Credentials:LCS W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2736
Mailing Address - Country:US
Mailing Address - Phone:518-475-6775
Mailing Address - Fax:518-475-6777
Practice Address - Street 1:369 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2736
Practice Address - Country:US
Practice Address - Phone:518-475-6775
Practice Address - Fax:518-475-6777
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074038-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical