Provider Demographics
NPI:1831485531
Name:RACKHAM, MERRILIE (MERRILIE RACKHAM)
Entity Type:Individual
Prefix:
First Name:MERRILIE
Middle Name:
Last Name:RACKHAM
Suffix:
Gender:F
Credentials:MERRILIE RACKHAM
Other - Prefix:
Other - First Name:MERRILIE
Other - Middle Name:
Other - Last Name:RACKHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT, CFLE
Mailing Address - Street 1:44 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4640
Mailing Address - Country:US
Mailing Address - Phone:856-579-7303
Mailing Address - Fax:856-579-7298
Practice Address - Street 1:44 COOPER ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4640
Practice Address - Country:US
Practice Address - Phone:856-579-7303
Practice Address - Fax:856-579-7298
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3TP10-008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist