Provider Demographics
NPI:1861429748
Name:MEREDITH, ANN UNDERWOOD (MA LCDP LCMHC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:UNDERWOOD
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MA LCDP LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-846-4009
Mailing Address - Fax:401-846-4009
Practice Address - Street 1:610 WAMPANOAG TRAIL
Practice Address - Street 2:EAST BAY MENTAL HEALTH
Practice Address - City:E PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-431-9870
Practice Address - Fax:401-435-7486
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00005101YA0400X
RI00038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6220028OtherUBH
RIO7826Medicaid
RI3010S1OtherBLUE CROSS
RI406682OtherBLUE CHIP