MEDICARE: CASSANDRA MERCURI LAC

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	37AC00529900	NJ
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	37AC00529900	NJ
3	101YP2500X	Professional Counselor	37AC00529900	NJ

General Provider Information

NPI Number	:	1215623863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA MERCURI LAC

Provider Business Mailing Address
First Line	:	9 BUSH PKWY
Second Line	:
City	:	E BRUNSWICK
State	:	NJ
Zip	:	08816-2208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 BUSH PKWY
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2208
Country	:	US
Telephone Number	:	732-239-7436
Fax Number	:

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

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	12/04/2025

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