Basic Information
| Provider Information | |||||||||
| NPI: | 1457882714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRITT | ||||||||
| FirstName: | MARY ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | CLC, PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 STOCKBRIDGE RD | ||||||||
| Address2: | COMMUNITY HEALTH PROGRAMS INC | ||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135289311 | ||||||||
| FaxNumber: | 4136440274 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 STOCKBRIDGE ROAD | ||||||||
| Address2: | COMMUNITY HEALTH PROGRAMS INC | ||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135289311 | ||||||||
| FaxNumber: | 4136440274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2017 | ||||||||
| LastUpdateDate: | 03/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174N00000X | Y | Other Service Providers | Lactation Consultant, Non-RN |
No ID Information.