Provider Demographics
NPI:1639403884
Name:MERRILL, SARAH MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2124
Mailing Address - Country:US
Mailing Address - Phone:619-325-3527
Mailing Address - Fax:619-325-3534
Practice Address - Street 1:2250 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:619-325-3527
Practice Address - Fax:619-325-3534
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33576106H00000X
CA790141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist