Provider Demographics
NPI:1538220769
Name:MEEHAN, NOEL (LCSW)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 56TH ST
Mailing Address - Street 2:SUITE 18M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4312
Mailing Address - Country:US
Mailing Address - Phone:212-247-0669
Mailing Address - Fax:
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:SUITE 18M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4312
Practice Address - Country:US
Practice Address - Phone:212-247-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0249851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS3420OtherOXFORD
NY179344OtherMHN
NY0063425OtherGHI
NYN01001Medicare ID - Type Unspecified