Provider Demographics
NPI:1184123044
Name:MEROLL, LYDIA M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:M
Last Name:MEROLL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 LEEDS ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3489
Mailing Address - Country:US
Mailing Address - Phone:562-445-3001
Mailing Address - Fax:
Practice Address - Street 1:44443 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3346
Practice Address - Country:US
Practice Address - Phone:661-726-2630
Practice Address - Fax:661-940-3412
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW791471041C0700X
CALCSW1174381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0655900249-8OtherHPSO