MEDICARE: PATRICIA FONSECA CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	37CA00045200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467592253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA FONSECA CADC

Provider Business Mailing Address
First Line	:	1430 TOWERS ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5447
Country	:	US
Telephone Number	:	732-905-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 AIRPORT ROAD
Second Line	:	PREFERRED BEHAVIORAL HEALTH
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701
Country	:	US
Telephone Number	:	732-367-4700
Fax Number	:	732-364-2253

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/09/2007

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