Provider Demographics
NPI:1144754219
Name:MERRILL, SAMANTHA (LCPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FORD QUINT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-5932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 CLEAVES ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4218
Practice Address - Country:US
Practice Address - Phone:207-743-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health