Provider Demographics
NPI:1134254659
Name:DAELHOUSEN, MEREDITH M (MASTERS)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:M
Last Name:DAELHOUSEN
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-2007
Mailing Address - Country:US
Mailing Address - Phone:413-695-5380
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN STREET
Practice Address - Street 2:BLGD 2, SUITE F
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-393-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA116144104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685661OtherTUFTS
MA1312677Medicaid
MAM18708OtherBLUE CROSS
MA1312677Medicaid