Provider Demographics
NPI:1376816082
Name:MERRICK, CHRISANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISANN
Middle Name:
Last Name:MERRICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2810
Mailing Address - Country:US
Mailing Address - Phone:339-788-1245
Mailing Address - Fax:
Practice Address - Street 1:51 MILL ST STE 8
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1651
Practice Address - Country:US
Practice Address - Phone:781-878-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical