MEDICARE: WAYNE MAGEE LCADC

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	37LC00205500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5312960	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1558778209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE MAGEE LCADC

Provider Business Mailing Address
First Line	:	35 S BURLINGTON RD
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-2262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 NORTH AVE
Second Line	:
City	:	PORT NORRIS
State	:	NJ
Zip	:	08349
Country	:	US
Telephone Number	:	856-332-0290
Fax Number	:

Authorized Official
Title or Position	:	SUBSTANCE ABUSE COUNSELOR
Name	:	MR. WAYNE MAGEE JR.
Credential	:	LCADC
Telephone Number	:	856-332-0290

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	01/21/2015

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