MEDICARE: MRS. KAREN JANIS MERRIGAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW 028649R	NY

General Provider Information

NPI Number	:	1063425262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN JANIS MERRIGAN LCSW

Provider Business Mailing Address
First Line	:	19 TATOMUCK RD
Second Line	:
City	:	POUND RIDGE
State	:	NY
Zip	:	10576-1431
Country	:	US
Telephone Number	:	914-764-4920
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 S BROADWAY
Second Line	:	SUITE 204
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-4400
Country	:	US
Telephone Number	:	914-764-4920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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