Provider Demographics
NPI:1013169697
Name:MEYER, BRENT ANDREW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ANDREW
Last Name:MEYER
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 1:2140 CRAWFORDVILLE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1009
Mailing Address - Country:US
Mailing Address - Phone:850-926-1900
Mailing Address - Fax:850-926-1930
Practice Address - Street 1:2140 CRAWFORDVILLE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1009
Practice Address - Country:US
Practice Address - Phone:850-926-1900
Practice Address - Fax:850-926-1930
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 89771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical