Provider Demographics
NPI:1700855855
Name:MERRIAM, DOROTHY B (APRN, BC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:B
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BEECH ST
Mailing Address - Street 2:RIVER VALLEY COUNSELING,TEEN CLINIC
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2767
Mailing Address - Country:US
Mailing Address - Phone:413-534-2033
Mailing Address - Fax:
Practice Address - Street 1:319 BEECH ST
Practice Address - Street 2:RIVER VALLY COUNSELING,TEEN CLINIC
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2767
Practice Address - Country:US
Practice Address - Phone:413-534-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS91495Medicare UPIN