Provider Demographics
NPI:1255340030
Name:MERBITZ, NANCY K (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:MERBITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 BEECHTREE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1072
Mailing Address - Country:US
Mailing Address - Phone:708-567-6778
Mailing Address - Fax:
Practice Address - Street 1:6296 RUCKER RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4852
Practice Address - Country:US
Practice Address - Phone:317-550-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006307103TC0700X
MI6301008968103TC0700X
IN20043655A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP45571Medicare UPIN
IL215593Medicare PIN