Provider Demographics
NPI:1861979585
Name:TAIT, MERIDETH P (BA, ICADC)
Entity type:Individual
Prefix:
First Name:MERIDETH
Middle Name:P
Last Name:TAIT
Suffix:
Gender:F
Credentials:BA, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PRINCETON CT
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1644
Mailing Address - Country:US
Mailing Address - Phone:215-932-6602
Mailing Address - Fax:
Practice Address - Street 1:638 NEWTOWN YARDLEY RD STE 1F
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1740
Practice Address - Country:US
Practice Address - Phone:215-874-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8823OtherPENNSYLVANIA CERTIFICATION BOARD