Provider Demographics
NPI:1588934392
Name:ELISEO, MEREDITH RAE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:RAE
Last Name:ELISEO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:RAE
Other - Last Name:POLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 GRAHAM FARM CIR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1086
Mailing Address - Country:US
Mailing Address - Phone:301-814-3019
Mailing Address - Fax:
Practice Address - Street 1:6655 FIRST PARK TEN BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4308
Practice Address - Country:US
Practice Address - Phone:210-496-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical