1992772834 NPI number — MS. PATRICIA A MERRITT LCSW

Table of content: MS. PATRICIA A MERRITT LCSW (NPI 1992772834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992772834 NPI number — MS. PATRICIA A MERRITT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRITT
Provider First Name:
PATRICIA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992772834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 HENNEPIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14072-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-235-1922
Provider Business Mailing Address Fax Number:
585-805-5126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4955 N BAILEY AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-235-1922
Provider Business Practice Location Address Fax Number:
585-805-5126
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0700711 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 070071-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00011249905 . This is a "ASO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160975538 . This is a "MAGNA CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "SENIOR CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050725000032 . This is a "FIDELIS FAMILY HEALTH PLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "UNIVERA TRANSITIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "PLUS MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "UNIVERA MEDICARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01465154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00011249905 . This is a "UNIVERA COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800010043 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "UNIVERA HEALTHCARE TRADIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000590275001 . This is a "BCBS WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050725000032 . This is a "FIDELIS CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050725000032 . This is a "FIDELIS MEDICAID" identifier . This identifiers is of the category "OTHER".




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