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NPI Code Detail

MEDICARE: MATTHEW BUSHWAY MERCER LICDC, LSW

MEDICARE: MATTHEW BUSHWAY MERCER LICDC, LSW
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.163024OH
2171M00000XCase Manager/Care CoordinatorCDCA.185422OH
3104100000XSocial WorkerS.2512894OH

General Provider Information

NPI Number : 1528792801
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW BUSHWAY MERCER LICDC, LSW
Provider Business Mailing Address
First Line : PO BOX 108
Second Line :
City : IRONTON
State : OH
Zip : 45638-0108
Country : US
Telephone Number : 740-532-1613
Fax Number : 740-879-0599
Provider Business Practice Location Address
First Line : 700 PARK AVE
Second Line :
City : IRONTON
State : OH
Zip : 45638-1502
Country : US
Telephone Number : 740-532-1613
Fax Number : 740-879-0599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2022
Last Update Date : 06/15/2026

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