Provider Demographics
NPI:1467596866
Name:MERWIN, ROY SINCLAIR JR (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:SINCLAIR
Last Name:MERWIN
Suffix:JR
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2201
Mailing Address - Country:US
Mailing Address - Phone:614-539-2242
Mailing Address - Fax:614-539-2245
Practice Address - Street 1:3725 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2201
Practice Address - Country:US
Practice Address - Phone:614-539-2242
Practice Address - Fax:614-539-2245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00033441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHR72189Medicare UPIN
OHMESW10482Medicare ID - Type Unspecified