Provider Demographics
NPI:1083652994
Name:MENIN, MARIS H (LSW)
Entity Type:Individual
Prefix:MS
First Name:MARIS
Middle Name:H
Last Name:MENIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1407
Mailing Address - Country:US
Mailing Address - Phone:610-630-2111
Mailing Address - Fax:610-630-4003
Practice Address - Street 1:3125 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1407
Practice Address - Country:US
Practice Address - Phone:610-630-2111
Practice Address - Fax:610-630-4003
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012486L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical