Provider Demographics
NPI:1912008509
Name:HARRIS, MEREDITH WHEELER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:WHEELER
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW,SAP
Mailing Address - Street 1:13670 METROPOLIS AVE
Mailing Address - Street 2:101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4346
Mailing Address - Country:US
Mailing Address - Phone:504-615-7217
Mailing Address - Fax:239-674-0304
Practice Address - Street 1:13670 METROPOLIS AVE
Practice Address - Street 2:101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4346
Practice Address - Country:US
Practice Address - Phone:504-615-7217
Practice Address - Fax:239-674-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45901041C0700X
FLSW131281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical