Healthcare Provider Details

I. General information

NPI: 1730442922
Provider Name (Legal Business Name): KATHRYN M MERRILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 COMPTON AVE STE 104
LOS ANGELES CA
90002-2805
US

IV. Provider business mailing address

2121 W TEMPLE ST
LOS ANGELES CA
90026-4915
US

V. Phone/Fax

Practice location:
  • Phone: 213-806-0859
  • Fax:
Mailing address:
  • Phone: 213-252-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: