Provider Demographics
NPI:1184238222
Name:CASIMIRO, MEREDITH (LCAT, R-DMT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:CASIMIRO
Suffix:
Gender:F
Credentials:LCAT, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-8001
Mailing Address - Country:US
Mailing Address - Phone:917-402-7338
Mailing Address - Fax:
Practice Address - Street 1:49 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-8001
Practice Address - Country:US
Practice Address - Phone:917-402-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002472225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist