Provider Demographics
NPI:1346764677
Name:MERRIMAN, CONSTANCE J (LPC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:J
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ROUTE 7 N
Mailing Address - Street 2:
Mailing Address - City:FALLS VILLAGE
Mailing Address - State:CT
Mailing Address - Zip Code:06031-1305
Mailing Address - Country:US
Mailing Address - Phone:860-824-9972
Mailing Address - Fax:
Practice Address - Street 1:4 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3412
Practice Address - Country:US
Practice Address - Phone:203-755-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional