Provider Demographics
NPI:1841282993
Name:CONDE, MERRIEL ANNE (CMSW, LMHP)
Entity type:Individual
Prefix:MS
First Name:MERRIEL
Middle Name:ANNE
Last Name:CONDE
Suffix:
Gender:F
Credentials:CMSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 MAPLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4001
Mailing Address - Country:US
Mailing Address - Phone:402-810-5589
Mailing Address - Fax:
Practice Address - Street 1:6107 MAPLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4001
Practice Address - Country:US
Practice Address - Phone:402-810-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP 2397101YM0800X
NECMSW 10381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
276248Medicare PIN