Provider Demographics
NPI:1669810321
Name:MARCO, MEREDITH (LCSW)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MARCO
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 1:17258 ESCALON DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4032
Mailing Address - Country:US
Mailing Address - Phone:424-256-5484
Mailing Address - Fax:
Practice Address - Street 1:17258 ESCALON DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4032
Practice Address - Country:US
Practice Address - Phone:424-256-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS235081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical