Provider Demographics
NPI:1831372663
Name:MERRICK, MICHAEL V (LMSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:MERRICK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1129
Mailing Address - Country:US
Mailing Address - Phone:641-683-3567
Mailing Address - Fax:
Practice Address - Street 1:307 E ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1129
Practice Address - Country:US
Practice Address - Phone:641-683-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IA03676104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor