Provider Demographics
NPI:1578605713
Name:MERO, JOSEPHINE (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:MERO
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:914 FOREST DR.
Mailing Address - City:CANADENSIS
Mailing Address - State:PA
Mailing Address - Zip Code:18325-0360
Mailing Address - Country:US
Mailing Address - Phone:570-595-3019
Mailing Address - Fax:570-595-3019
Practice Address - Street 1:33 ROUTE 390
Practice Address - Street 2:
Practice Address - City:MOUNTAINHOME
Practice Address - State:PA
Practice Address - Zip Code:18342
Practice Address - Country:US
Practice Address - Phone:570-595-9590
Practice Address - Fax:570-595-3019
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1234501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11615737OtherCAQH#