Provider Demographics
NPI:1902179989
Name:MERION CREEK MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:MERION CREEK MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CAIAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:855-637-4662
Mailing Address - Street 1:1 CENTER SQ
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3013
Mailing Address - Country:US
Mailing Address - Phone:855-637-4662
Mailing Address - Fax:
Practice Address - Street 1:1 CENTER SQ
Practice Address - Street 2:SUITE 208
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3013
Practice Address - Country:US
Practice Address - Phone:855-637-4662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty