Provider Demographics
NPI:1639964059
Name:MERRITT, RONALD S (RADT 1)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:MERRITT
Suffix:
Gender:
Credentials:RADT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 9TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2852
Mailing Address - Country:US
Mailing Address - Phone:619-714-0608
Mailing Address - Fax:619-426-0034
Practice Address - Street 1:73 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1124
Practice Address - Country:US
Practice Address - Phone:619-426-4801
Practice Address - Fax:619-426-0034
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1581520924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)