Healthcare Provider Details

I. General information

NPI: 1609460732
Provider Name (Legal Business Name): MERCEDES NOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ROUTE 70 E STE G101
MARLTON NJ
08053-2548
US

IV. Provider business mailing address

60 W LANDIS AVE
VINELAND NJ
08360-8132
US

V. Phone/Fax

Practice location:
  • Phone: 856-818-4020
  • Fax: 732-479-6751
Mailing address:
  • Phone: 856-772-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06784000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: