MEDICARE: LUZ E FONTANEZ MA

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

General Provider Information

NPI Number	:	1316249022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ E FONTANEZ MA

Provider Business Mailing Address
First Line	:	2201 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3582
Country	:	US
Telephone Number	:	201-558-3725
Fax Number	:	201-392-5048

Provider Business Practice Location Address
First Line	:	2201 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3582
Country	:	US
Telephone Number	:	201-558-3725
Fax Number	:	201-392-5048

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/06/2010

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Directions to “ LUZ E FONTANEZ MA” Practice Location

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