MEDICARE: MERCED COUNSELING, INC.

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	1041C0700X	Clinical Social Worker	SW8129	FL

General Provider Information

NPI Number	:	1750431763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCED COUNSELING, INC.

Provider Business Mailing Address
First Line	:	1342 COLONIAL BLVD
Second Line	:	BUILDING F SUITE 41A
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1013
Country	:	US
Telephone Number	:	239-277-3117
Fax Number	:	239-936-2696

Provider Business Practice Location Address
First Line	:	1342 COLONIAL BLVD
Second Line	:	BUILDING F SUITE 41A
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1013
Country	:	US
Telephone Number	:	239-277-3117
Fax Number	:	239-936-2696

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	CYNTHIA MERCED
Credential	:	LCSW
Telephone Number	:	239-277-3117

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	06/16/2008

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