Provider Demographics
NPI:1851456842
Name:MERRITT, DENNIS L (MA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2063
Mailing Address - Country:US
Mailing Address - Phone:608-255-9330
Mailing Address - Fax:608-255-7810
Practice Address - Street 1:1619 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2063
Practice Address - Country:US
Practice Address - Phone:608-255-9330
Practice Address - Fax:608-255-7810
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3147-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39200700Medicaid