MEDICARE: MERCER COUNCIL ON ALCOHOLISM AND DRUG ADDICTION

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1023857950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCER COUNCIL ON ALCOHOLISM AND DRUG ADDICTION

Provider Business Mailing Address
First Line	:	1931 BRUNSWICK AVENUE
Second Line	:
City	:	LAWRENCE TOWNSHIP
State	:	NJ
Zip	:	08648-4237
Country	:	US
Telephone Number	:	609-396-5874
Fax Number	:	609-396-3451

Provider Business Practice Location Address
First Line	:	1931 BRUNSWICK AVENUE
Second Line	:
City	:	LAWRENCE TOWNSHIP
State	:	NJ
Zip	:	08648-4237
Country	:	US
Telephone Number	:	609-396-5874
Fax Number	:	609-396-3451

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/CLINICAL SUPERVI
Name	:	MS. MARGARITA LEAHY
Credential	:	LPC, LCADC, ACS
Telephone Number	:	609-396-5874

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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