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General NPI Number Information
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NPI Number | 1295587749
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Entity Type | Individual
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Provider Name | SAMANTHA ANN MERSE
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Gender | Female
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 40 EISENHOWER DR
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City | PARAMUS
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State | NJ
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Zip | 07652-1404
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Country | US
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Telephone | 201-291-0055
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Fax | 201-291-0888
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Provider Business Mailing Address
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Address Line | 40 MAPLEWOOD AVE
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City | BOGOTA
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State | NJ
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Zip | 07603-1710
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Country | US
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Telephone | 201-916-3980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00668100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 23-021
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License Number State | NJ
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