Healthcare Provider Details

I. General information

NPI: 1982160537
Provider Name (Legal Business Name): NANCY MERLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY PARRA

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 6TH STREET FRONTAGE RD E
SPRINGFIELD IL
62703-5128
US

IV. Provider business mailing address

137 PINEHURST DR
SPRINGFIELD IL
62704-3122
US

V. Phone/Fax

Practice location:
  • Phone: 217-585-1180
  • Fax:
Mailing address:
  • Phone: 630-229-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022022
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.103457
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: