Provider Demographics
NPI:1760939805
Name:MERRILL, ROBERT W JR (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:MERRILL
Suffix:JR
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4530
Mailing Address - Country:US
Mailing Address - Phone:717-795-0330
Mailing Address - Fax:717-795-0407
Practice Address - Street 1:960 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4530
Practice Address - Country:US
Practice Address - Phone:717-795-0330
Practice Address - Fax:717-795-0407
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132946104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker