Provider Demographics
NPI:1316698418
Name:FITZSIMONS, MEREDITH (MHC-LP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:FITZSIMONS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:MERE
Other - Middle Name:
Other - Last Name:FITZSIMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP-MHC
Mailing Address - Street 1:379 SAINT CLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2517
Mailing Address - Country:US
Mailing Address - Phone:913-558-1051
Mailing Address - Fax:
Practice Address - Street 1:136 MADISON AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6796
Practice Address - Country:US
Practice Address - Phone:212-828-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP107340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health