MEDICARE: CARRIE MICHELE MERINO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1710295597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MICHELE MERINO

Provider Business Mailing Address
First Line	:	1943 WINNEBAGO ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5314
Country	:	US
Telephone Number	:	608-618-4069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1943 WINNEBAGO ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5314
Country	:	US
Telephone Number	:	608-618-4069
Fax Number	:

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	03/07/2023

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