Provider Demographics
NPI:1043325921
Name:MERICAL, ANNE ELISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:ELISE
Last Name:MERICAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36541 WILD ROSE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975
Mailing Address - Country:US
Mailing Address - Phone:724-454-0810
Mailing Address - Fax:302-564-7465
Practice Address - Street 1:32828 REBA ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967
Practice Address - Country:US
Practice Address - Phone:724-454-0810
Practice Address - Fax:302-564-7465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012318L104100000X
DEQ1-00016161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000863Medicaid