MEDICARE: ELIZABETH S ADAIR

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	:	1508392630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH S ADAIR

Provider Business Mailing Address
First Line	:	6821 BLACK HORSE PIKE
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-4101
Country	:	US
Telephone Number	:	856-863-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 BLACK HORSE PIKE
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-4101
Country	:	US
Telephone Number	:	856-863-0006
Fax Number	:

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

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/10/2017

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