Provider Demographics
NPI:1760671382
Name:MERRILL, CRYSTAL A (MSW, LCSW-C)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:A
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ELK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-2131
Mailing Address - Country:US
Mailing Address - Phone:301-616-6025
Mailing Address - Fax:
Practice Address - Street 1:76 ELK RIDGE LN
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-2131
Practice Address - Country:US
Practice Address - Phone:301-616-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical