Healthcare Provider Details

I. General information

NPI: 1578273843
Provider Name (Legal Business Name): CHRISTINA MARIA ANNE MERRIFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ERIE BLVD W STE 302
SYRACUSE NY
13204-2463
US

IV. Provider business mailing address

620 ERIE BLVD W STE 302
SYRACUSE NY
13204-2463
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7363
  • Fax:
Mailing address:
  • Phone: 315-472-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: