MEDICARE: MS. JERI FATIA MENTOR LPC

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	37LC00328700	NJ
2	101YP2500X	Professional Counselor	37PC00867400	NJ

General Provider Information

NPI Number	:	1528721651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JERI FATIA MENTOR LPC

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	732-908-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 PERRY ST
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08618-3968
Country	:	US
Telephone Number	:	609-394-8988
Fax Number	:	609-394-0023

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	12/10/2025

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