Provider Demographics
NPI:1881806883
Name:BARTLETT, MERRIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MERRIE
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1607
Mailing Address - Country:US
Mailing Address - Phone:631-838-8751
Mailing Address - Fax:631-396-1199
Practice Address - Street 1:1111 BROADHOLLOW RD
Practice Address - Street 2:SUITE 320
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4820
Practice Address - Country:US
Practice Address - Phone:631-838-8751
Practice Address - Fax:631-396-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0600451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health