Provider Demographics
NPI:1568609790
Name:MERRILL, ELIZABETH GENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GENE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1248
Mailing Address - Country:US
Mailing Address - Phone:415-307-8258
Mailing Address - Fax:
Practice Address - Street 1:379 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1248
Practice Address - Country:US
Practice Address - Phone:415-307-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical