MEDICARE: MR. RICHARD L MERILLAT 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	SW7100	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417970245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD L MERILLAT LCSW

Provider Business Mailing Address
First Line	:	1222 SE 47TH ST
Second Line	:	SUITE 217
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9661
Country	:	US
Telephone Number	:	239-829-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 SE 47TH ST
Second Line	:	SUITE 217
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9661
Country	:	US
Telephone Number	:	239-829-5480
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/28/2014

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