=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760963953
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERRILL BETH ADLER LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2018
-----------------------------------------------------
Last Update Date | 08/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 FRANKLIN ST STE 110
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-6265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-875-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 STRATHMORE RD APT 304
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-7188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-277-6796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 103560
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------