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General NPI Number Information
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NPI Number | 1770095697
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Entity Type | Individual
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Provider Name | ANITA MERRILL LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 4 FULLER ST
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City | ALEXANDRIA BAY
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State | NY
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Zip | 13607-1316
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Country | US
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Telephone | 315-482-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 301 COUNTY ROUTE 4
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City | OGDENSBURG
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State | NY
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Zip | 13669-5334
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Country | US
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Telephone | 315-212-1651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009737-01
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License Number State | NY
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