Provider Demographics
NPI:1316652860
Name:MERVOS, DANA LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LYNN
Last Name:MERVOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 BLACKHORSE HILL RD BSMT
Mailing Address - Street 2:MAIL CODE: 116D/BSMT
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2040
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD BSMT
Practice Address - Street 2:MAIL CODE: 116D/BSMT
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0201641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical