Provider Demographics
NPI:1265420863
Name:HALEM, MERYL HARMON (LCSW, LMFT)
Entity type:Individual
Prefix:MS
First Name:MERYL
Middle Name:HARMON
Last Name:HALEM
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 BELL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2019
Mailing Address - Country:US
Mailing Address - Phone:718-423-0887
Mailing Address - Fax:516-365-1315
Practice Address - Street 1:2391 BELL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2019
Practice Address - Country:US
Practice Address - Phone:718-423-0887
Practice Address - Fax:516-365-1315
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0339671041C0700X
NY000016-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR27295Medicare UPIN
NY00092Medicare ID - Type Unspecified