Provider Demographics
NPI:1861226599
Name:MERRILL, MEA KATHRINE (LMSW-CC)
Entity type:Individual
Prefix:MRS
First Name:MEA
Middle Name:KATHRINE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:MEA
Other - Middle Name:KATHRINE
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:491 US ROUTE 1 STE 23
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-7022
Mailing Address - Country:US
Mailing Address - Phone:207-894-8104
Mailing Address - Fax:207-544-5070
Practice Address - Street 1:491 US ROUTE 1 STE 23
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7022
Practice Address - Country:US
Practice Address - Phone:207-894-8104
Practice Address - Fax:207-544-5070
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC19790101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor