Provider Demographics
NPI:1376023408
Name:VOGEL, MEREDITH J (LMSW-CC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:J
Last Name:VOGEL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WINTER ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-4032
Mailing Address - Country:US
Mailing Address - Phone:443-974-0660
Mailing Address - Fax:
Practice Address - Street 1:75 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6031
Practice Address - Country:US
Practice Address - Phone:207-795-4180
Practice Address - Fax:207-753-6419
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC17117104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker