Provider Demographics
NPI:1285181750
Name:MERVICH, KRISTIN APRIL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:APRIL
Last Name:MERVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:APRIL
Other - Last Name:KOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3509 E SHEA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3337
Mailing Address - Country:US
Mailing Address - Phone:872-333-9282
Mailing Address - Fax:480-581-7474
Practice Address - Street 1:3509 E SHEA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3337
Practice Address - Country:US
Practice Address - Phone:872-333-9282
Practice Address - Fax:480-581-7474
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0202361041C0700X
AZLCSW-175611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical