Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCSW 29848 | CA |
NPI | 1003111048 |
---|---|
Provider Name | Jennifer Lynn Merrill |
First Address | Burlingame, CA 94010-2305 |
Second Address | Burlingame, CA 94010-2305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2011 |
Last Update Date | 29/04/2013 |