Doctor Name: | EDNY MERVEILLE |
NPI Number: | 1013256502 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC |
License Number: | |
Business Practice Address: | 20 Sickles Ave New Rochelle, NY - 108014030 |
Business Phone Number: | 9143804327 |
Business Fax Number: | 9146322217 |
Mailing Address: | 20 Sickles Ave, NEW ROCHELLE |
State: | NY |
Postal Code: | 108014030 |
Phone Number: | 9143804327 |
Fax Number: | 9146322217 |
NPI Enumeration Date: | 02/05/2013 |
NPI Last Update Date: | 02/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |