Provider Demographics
NPI:1316335110
Name:DIETRICH, MEREDITH (LMSW)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 77TH ST
Mailing Address - Street 2:3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2251
Mailing Address - Country:US
Mailing Address - Phone:310-614-3675
Mailing Address - Fax:
Practice Address - Street 1:2590 FRISBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3240
Practice Address - Country:US
Practice Address - Phone:718-239-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091138-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical