Provider Demographics
NPI:1811452642
Name:MERCEDES & FAMILY
Entity type:Organization
Organization Name:MERCEDES & FAMILY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCEDES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-375-7305
Mailing Address - Street 1:223 WESSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2727
Mailing Address - Country:US
Mailing Address - Phone:201-375-7305
Mailing Address - Fax:
Practice Address - Street 1:223 WESSINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2727
Practice Address - Country:US
Practice Address - Phone:201-375-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty