Provider Demographics
NPI:1275132599
Name:MERRITT, MAURA CAITLYN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:CAITLYN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:MAURA
Other - Middle Name:CAITLYN
Other - Last Name:OATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4032 HALLBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3290
Mailing Address - Country:US
Mailing Address - Phone:551-497-0407
Mailing Address - Fax:
Practice Address - Street 1:4032 HALLBOROUGH WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3290
Practice Address - Country:US
Practice Address - Phone:551-497-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist