MEDICARE: DEEDLES, LLC

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

General Provider Information

NPI Number	:	1861177859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEDLES, LLC

Provider Business Mailing Address
First Line	:	215 KINDERKAMACK RD APT N4
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-2090
Country	:	US
Telephone Number	:	201-993-7807
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 KINDERKAMACK RD
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-2089
Country	:	US
Telephone Number	:	201-993-7807
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEIRDRE A MONTEZ
Credential	:	CADC
Telephone Number	:	201-993-7807

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	07/31/2023

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