MEDICARE: MR. BILL RENE MERITET 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	R042965	NY

General Provider Information

NPI Number	:	1245277862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BILL RENE MERITET LCSW

Provider Business Mailing Address
First Line	:	30 COUNTRY VIEW LN
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1265
Country	:	US
Telephone Number	:	631-924-7568
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 COUNTRY VIEW LN
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1265
Country	:	US
Telephone Number	:	631-924-7568
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/16/2015

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