MEDICARE: ERICA N CANNEDY LPC, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00551300	NJ

General Provider Information

NPI Number	:	1023436870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA N CANNEDY LPC, LCADC

Provider Business Mailing Address
First Line	:	301 S LIVINGSTON AVE STE 205D
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3929
Country	:	US
Telephone Number	:	201-367-1667
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S LIVINGSTON AVE STE 205D
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3929
Country	:	US
Telephone Number	:	201-367-1667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	10/29/2018

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