Basic Information
| Provider Information | |||||||||
| NPI: | 1023137379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | LINDSAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11353 78TH ST E | ||||||||
| Address2: | |||||||||
| City: | PARRISH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342192747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277091326 | ||||||||
| FaxNumber: | 7277674715 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 7TH AVE S | ||||||||
| Address2: | DEPARTMENT 7470 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277674403 | ||||||||
| FaxNumber: | 7277674715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
ID Information
| ID | Type | State | Issuer | Description | 766816300 | 05 | FL | MEDICAID |