MEDICARE: KATHRYN M MERRILL 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	88317	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ91892Z	OTHER	CA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#

General Provider Information

NPI Number	:	1730442922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN M MERRILL LCSW

Provider Business Mailing Address
First Line	:	2121 W TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4915
Country	:	US
Telephone Number	:	213-252-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	10221 COMPTON AVE STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-2805
Country	:	US
Telephone Number	:	213-806-0859
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	08/12/2019

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