Provider Demographics
NPI:1801462635
Name:MERIWETHER, AUTUMN (MSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:MERIWETHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 68TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-6136
Mailing Address - Country:US
Mailing Address - Phone:813-245-5801
Mailing Address - Fax:
Practice Address - Street 1:22633 MARSH WREN DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-6432
Practice Address - Country:US
Practice Address - Phone:813-245-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW113231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical