Provider Demographics
NPI:1619035433
Name:MERRITT, MARIA VICENTA (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VICENTA
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24715 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3207
Mailing Address - Country:US
Mailing Address - Phone:586-777-9000
Mailing Address - Fax:586-777-0823
Practice Address - Street 1:24715 LITTLE MACK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3207
Practice Address - Country:US
Practice Address - Phone:586-777-9000
Practice Address - Fax:586-777-0823
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010621491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical