Provider Demographics
NPI:1720553084
Name:FIORILLI, MERISSA
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:
Last Name:FIORILLI
Suffix:
Gender:F
Credentials:
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 15
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:OH
Mailing Address - Zip Code:43027-0015
Mailing Address - Country:US
Mailing Address - Phone:740-398-0512
Mailing Address - Fax:
Practice Address - Street 1:1095 HARCOURT RD STE B
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4476
Practice Address - Country:US
Practice Address - Phone:740-848-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.19033531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH032195Medicaid