Doctor Name: | DIANE LOUISE MERCER |
NPI Number: | 1598985301 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CASAC-T |
License Number: | 18272 |
Business Practice Address: | 240 Long Island Ave # A Wyandanch, NY - 117983123 |
Business Phone Number: | 6319208250 |
Business Fax Number: | 6319208251 |
Mailing Address: | 34 King St, WYANDANCH |
State: | NY |
Postal Code: | 117984412 |
Phone Number: | 6319208250 |
Fax Number: | 6319208251 |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 18272 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |