Basic Information
Provider Information
NPI: 1376771378
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MERKER
FirstName: LAWRENCE
MiddleName: J.
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3 BARKER AVE
Address2: 4TH FLOOR
City: WHITE PLAINS
State: NY
PostalCode: 106011509
CountryCode: US
TelephoneNumber: 9149491199
FaxNumber: 9149491245
Practice Location
Address1: 3 BARKER AVE
Address2: 4TH FLOOR
City: WHITE PLAINS
State: NY
PostalCode: 106011509
CountryCode: US
TelephoneNumber: 9149491199
FaxNumber: 9149491245
Other Information
ProviderEnumerationDate: 06/29/2009
LastUpdateDate: 06/29/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X017063NYY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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