=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730327131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH MERRIMAN LMFT, LADC I
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2009
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SILVER STREET 106
-----------------------------------------------------
City | AGAWAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01001-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-789-9198
-----------------------------------------------------
Fax | 413-789-6322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SILVER STREET 106
-----------------------------------------------------
City | AGAWAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01001-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-789-9198
-----------------------------------------------------
Fax | 413-789-6322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 924
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1126
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------