Provider Demographics
NPI:1740499698
Name:KANTOR, MEREDITH (MED)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1711
Mailing Address - Country:US
Mailing Address - Phone:617-868-5450
Mailing Address - Fax:617-868-7811
Practice Address - Street 1:7 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1711
Practice Address - Country:US
Practice Address - Phone:617-868-5450
Practice Address - Fax:617-868-7811
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208512101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA208512OtherSOC WORK LICENSE