Provider Demographics
NPI:1508110644
Name:MERRIAM, DANIELLE RACHAEL (LPC, SAC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RACHAEL
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 DELA VINA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3913
Mailing Address - Country:US
Mailing Address - Phone:920-988-0955
Mailing Address - Fax:
Practice Address - Street 1:435 DELA VINA AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3913
Practice Address - Country:US
Practice Address - Phone:920-988-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-27
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000-088574Medicare PIN
WI42170300Medicaid