Provider Demographics
NPI:1508950262
Name:MERTEN, DONNA MARIA (MSW/ LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIA
Last Name:MERTEN
Suffix:
Gender:F
Credentials:MSW/ LCSW
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:MARIA
Other - Last Name:LATORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW/ LCSW
Mailing Address - Street 1:366 LUM AVENUE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7515
Mailing Address - Country:US
Mailing Address - Phone:908-687-4520
Mailing Address - Fax:908-687-4520
Practice Address - Street 1:950 WEST CHESTNUT STREET
Practice Address - Street 2:SUITE # 102
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-687-4520
Practice Address - Fax:908-687-4520
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043900001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058505Medicare ID - Type Unspecified