Provider Demographics
NPI:1649231960
Name:MERINO, ELBA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELBA
Middle Name:M
Last Name:MERINO
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 1:348 13TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6177
Mailing Address - Country:US
Mailing Address - Phone:718-584-6840
Mailing Address - Fax:
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6177
Practice Address - Country:US
Practice Address - Phone:718-788-2468
Practice Address - Fax:718-788-8274
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077905-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1649231960Medicare PIN