Provider Demographics
NPI:1326124181
Name:MERRILL, GAY L (CASAC MAC)
Entity Type:Individual
Prefix:MS
First Name:GAY
Middle Name:L
Last Name:MERRILL
Suffix:
Gender:F
Credentials:CASAC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 STOODLEY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-3338
Mailing Address - Country:US
Mailing Address - Phone:607-431-1030
Mailing Address - Fax:
Practice Address - Street 1:8-12 DIETZ ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1849
Practice Address - Country:US
Practice Address - Phone:607-431-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)