Provider Demographics
NPI:1841015906
Name:MERRILL, CARRIE A (LCSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PERIMETER AVE
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-5741
Mailing Address - Country:US
Mailing Address - Phone:207-232-2091
Mailing Address - Fax:
Practice Address - Street 1:7 RAILROAD AVE STE 317
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1546
Practice Address - Country:US
Practice Address - Phone:207-222-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC212731041C0700X
MELC242781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical