MEDICARE: BETH MERRITT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R045386-1	NY

General Provider Information

NPI Number	:	1245535400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH MERRITT LCSW

Provider Business Mailing Address
First Line	:	108 BROOK HOLLOW DR
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-8652
Country	:	US
Telephone Number	:	845-534-2172
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 BROOK HOLLOW DR
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-8652
Country	:	US
Telephone Number	:	845-534-2172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/20/2011

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