Provider Demographics
NPI:1225193113
Name:MERKLE, CHRISTINE LOUISE (PHD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:MERKLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 HIGHLAND AVE
Mailing Address - Street 2:#6
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1635
Mailing Address - Country:US
Mailing Address - Phone:781-444-4644
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:FULTON 254 COUNSELING OFFICE, BOSTON COLLEGE
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3800
Practice Address - Country:US
Practice Address - Phone:617-552-3927
Practice Address - Fax:617-552-0478
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2354103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist