Provider Demographics
NPI:1538935614
Name:MERRIAM, MARIAH ELIZABETH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:ELIZABETH
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:ELIZABETH
Other - Last Name:ERTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05702-0222
Mailing Address - Country:US
Mailing Address - Phone:802-775-1000
Mailing Address - Fax:802-772-2757
Practice Address - Street 1:78 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4591
Practice Address - Country:US
Practice Address - Phone:802-775-1000
Practice Address - Fax:802-772-4757
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 172V00000X
VT089.01357401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker