Provider Demographics
NPI:1912148321
Name:ST. GEORGE, MERIDITH JEANE (MS)
Entity type:Individual
Prefix:MRS
First Name:MERIDITH
Middle Name:JEANE
Last Name:ST. GEORGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MERIDITH
Other - Middle Name:JEANE
Other - Last Name:MALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-2024
Mailing Address - Country:US
Mailing Address - Phone:617-347-1862
Mailing Address - Fax:
Practice Address - Street 1:545 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4727
Practice Address - Country:US
Practice Address - Phone:978-829-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health