Provider Demographics
NPI:1962615930
Name:MERVES-OKIN, LOUISE R (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:R
Last Name:MERVES-OKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE WYNCOTR HOUSE SUITE 6A-2
Mailing Address - Street 2:25 WASHINGTON LANE
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095
Mailing Address - Country:US
Mailing Address - Phone:215-576-6523
Mailing Address - Fax:215-576-6999
Practice Address - Street 1:25 WASHINGTON LN
Practice Address - Street 2:SUITE 6A-2
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1403
Practice Address - Country:US
Practice Address - Phone:215-576-6523
Practice Address - Fax:215-576-6999
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005541-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAME580189Medicare ID - Type Unspecified