Provider Demographics
NPI:1114083326
Name:MERRILL, HAROLD G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:G
Last Name:MERRILL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2234 DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2017
Mailing Address - Country:US
Mailing Address - Phone:859-380-2987
Mailing Address - Fax:
Practice Address - Street 1:2234 DOMINION DR
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2017
Practice Address - Country:US
Practice Address - Phone:859-380-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-20041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical