Healthcare Provider Details

I. General information

NPI: 1578605713
Provider Name (Legal Business Name): JOSEPHINE MERO MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ROUTE 390
MOUNTAINHOME PA
18342
US

IV. Provider business mailing address

PO BOX 360 914 FOREST DR.
CANADENSIS PA
18325-0360
US

V. Phone/Fax

Practice location:
  • Phone: 570-595-9590
  • Fax: 570-595-3019
Mailing address:
  • Phone: 570-595-3019
  • Fax: 570-595-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW123450
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier11615737
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAQH#

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: