Provider Demographics
NPI:1649986233
Name:MEEHAN, EDWARD DANIEL (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:DANIEL
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3230
Mailing Address - Country:US
Mailing Address - Phone:612-245-3658
Mailing Address - Fax:
Practice Address - Street 1:14665 GALAXIE AVE STE 210
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4510
Practice Address - Country:US
Practice Address - Phone:952-431-6033
Practice Address - Fax:952-431-3225
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN291111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical