Provider Demographics
NPI:1487877320
Name:MEADOWS, MARTHA LYNNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LYNNE
Last Name:MEADOWS
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 1:4571 WHITAKER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4631
Mailing Address - Country:US
Mailing Address - Phone:215-833-0420
Mailing Address - Fax:215-914-1663
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6357
Practice Address - Country:US
Practice Address - Phone:215-914-2119
Practice Address - Fax:215-914-1553
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0128331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP12635Medicare UPIN
PA041632Medicare ID - Type UnspecifiedPSYCHOTHERAPIST