Provider Demographics
NPI:1619988797
Name:MERRITT, SCOTT ADAM (MA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ADAM
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MA
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 558
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-0558
Mailing Address - Country:US
Mailing Address - Phone:814-336-1011
Mailing Address - Fax:814-333-4428
Practice Address - Street 1:16269 CONNEAUT LAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3887
Practice Address - Country:US
Practice Address - Phone:814-336-1011
Practice Address - Fax:814-333-4428
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006901-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical