Provider Demographics
NPI:1013464809
Name:SUSAN B MERRICK, LCSW, DCSW, LLC
Entity Type:Organization
Organization Name:SUSAN B MERRICK, LCSW, DCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BLANCHARD
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-781-3403
Mailing Address - Street 1:PO BOX 86706
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97286-0706
Mailing Address - Country:US
Mailing Address - Phone:503-781-3403
Mailing Address - Fax:
Practice Address - Street 1:510 SW 3RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2543
Practice Address - Country:US
Practice Address - Phone:503-781-3403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6896251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health