Provider Demographics
NPI:1972633279
Name:MEEHAN, ELIZABETH BURGESS
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BURGESS
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MEEHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:222 WEST 14 STREET
Mailing Address - Street 2:4F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7204
Mailing Address - Country:US
Mailing Address - Phone:212-255-5571
Mailing Address - Fax:212-777-1407
Practice Address - Street 1:222 WEST 14 STREET
Practice Address - Street 2:4F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7204
Practice Address - Country:US
Practice Address - Phone:212-255-5571
Practice Address - Fax:212-777-1407
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR2132811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P586134OtherOXFORD HEALTH PLANS PROVI
146948OtherVALUE OPTIONS GHI BMP PRO
N35831Medicare ID - Type Unspecified