MEDICARE: MERCEDES & FAMILY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1811452642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCEDES & FAMILY

Provider Business Mailing Address
First Line	:	223 WESSINGTON AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2727
Country	:	US
Telephone Number	:	201-375-7305
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 WESSINGTON AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2727
Country	:	US
Telephone Number	:	201-375-7305
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	MR. BILLY MERCEDES
Credential	:	LPC
Telephone Number	:	201-375-7305

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	12/06/2023

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Directions to “MERCEDES & FAMILY ” Practice Location

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