Provider Demographics
NPI:1649480948
Name:MERRIHEW, CAROL JANE (LCSW-R)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JANE
Last Name:MERRIHEW
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-2519
Mailing Address - Country:US
Mailing Address - Phone:518-359-2636
Mailing Address - Fax:
Practice Address - Street 1:2778 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-2519
Practice Address - Country:US
Practice Address - Phone:518-359-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0466451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53602AMedicaid