Provider Demographics
NPI:1366069247
Name:MEREDITH, NICOLE RENEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RENEE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 W JUDGE PEREZ DR STE 1300
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-1736
Mailing Address - Country:US
Mailing Address - Phone:504-575-3712
Mailing Address - Fax:
Practice Address - Street 1:8050 W JUDGE PEREZ DR STE 1300
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1736
Practice Address - Country:US
Practice Address - Phone:504-575-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA875061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87506OtherCA BBS