Provider Demographics
NPI:1609020247
Name:BRADDOCK, MEREDITH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:BRADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:766 PENLON CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-5097
Mailing Address - Country:US
Mailing Address - Phone:406-438-7156
Mailing Address - Fax:
Practice Address - Street 1:766 PENLON CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-5097
Practice Address - Country:US
Practice Address - Phone:406-438-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW108121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical