Provider Demographics
NPI:1538500558
Name:GLIDDEN, MEREDITH L (LCAT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAVEMEYER ST
Mailing Address - Street 2:3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2172
Mailing Address - Country:US
Mailing Address - Phone:646-469-3547
Mailing Address - Fax:
Practice Address - Street 1:30 HAVEMEYER ST
Practice Address - Street 2:3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2172
Practice Address - Country:US
Practice Address - Phone:646-469-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1634-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health