Provider Demographics
NPI:1245277862
Name:MERITET, BILL RENE (LCSW)
Entity type:Individual
Prefix:MR
First Name:BILL
Middle Name:RENE
Last Name:MERITET
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:RENE
Other - Last Name:MERITET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:30 COUNTRY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1265
Mailing Address - Country:US
Mailing Address - Phone:631-924-7568
Mailing Address - Fax:
Practice Address - Street 1:30 COUNTRY VIEW LN
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1265
Practice Address - Country:US
Practice Address - Phone:631-924-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0429651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical