MEDICARE: MS. MARIA M. MEEHAN L.P.C.

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	37PC00303300	NJ

General Provider Information

NPI Number	:	1568676567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA M. MEEHAN L.P.C.

Provider Business Mailing Address
First Line	:	5 CHELSEA DR
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2734
Country	:	US
Telephone Number	:	973-927-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 SUSSEX TPKE
Second Line	:	SUITE 4
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2944
Country	:	US
Telephone Number	:	973-895-1420
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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