MEDICARE: MS. MERCEDES PETERMAN

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	101YM0800X	Mental Health Counselor	LGP9022	MD

General Provider Information

NPI Number	:	1154277119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERCEDES PETERMAN

Provider Business Mailing Address
First Line	:	4998 DORSEY HALL DR UNIT A5
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7729
Country	:	US
Telephone Number	:	240-328-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	4998 DORSEY HALL DR UNIT A5
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7729
Country	:	US
Telephone Number	:	240-328-9935
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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