Healthcare Provider Details

I. General information

NPI: 1447623962
Provider Name (Legal Business Name): MERYL LAMMERS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 07/08/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 N PROVIDENCE ROAD
MEDIA PA
19063
US

IV. Provider business mailing address

149 MORTON AVE
BROOMALL PA
19008-2943
US

V. Phone/Fax

Practice location:
  • Phone: 215-990-0362
  • Fax:
Mailing address:
  • Phone: 215-990-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number07469
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: