Provider Demographics
NPI:1124141668
Name:MEYER, NORINE A (LICSW)
Entity type:Individual
Prefix:
First Name:NORINE
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NORINE
Other - Middle Name:A
Other - Last Name:MEYER WEEKLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-414-2132
Mailing Address - Fax:360-414-2024
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-414-2132
Practice Address - Fax:360-414-2024
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000081051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8855203Medicare ID - Type UnspecifiedPROVIDER ID