MEDICARE: ZONDA JEANNE MERCER M.D.

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	101YP2500X	Professional Counselor	31932	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B11453	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1487751418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZONDA JEANNE MERCER M.D.

Provider Business Mailing Address
First Line	:	47 COGSWELL AVE
Second Line	:	APT 21
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2045
Country	:	US
Telephone Number	:	617-547-3947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-1703
Country	:	US
Telephone Number	:	617-547-3947
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/30/2016

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