Provider Demographics
NPI:1427466374
Name:MEREDITH HARRIS LLC
Entity type:Organization
Organization Name:MEREDITH HARRIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:WHEELER
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW,SAP
Authorized Official - Phone:504-615-7217
Mailing Address - Street 1:13670 METROPOLIS AVE
Mailing Address - Street 2:101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4346
Mailing Address - Country:US
Mailing Address - Phone:504-615-7217
Mailing Address - Fax:239-674-0304
Practice Address - Street 1:13670 METROPOLIS AVE
Practice Address - Street 2:101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4346
Practice Address - Country:US
Practice Address - Phone:504-615-7217
Practice Address - Fax:239-674-0304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEREDITH W. HARRIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-23
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600806993Medicaid