Provider Demographics
NPI:1588095582
Name:MERCER-MEDEIROS, SARA-JANE ALLISON
Entity type:Individual
Prefix:
First Name:SARA-JANE
Middle Name:ALLISON
Last Name:MERCER-MEDEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 STATE ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1731
Mailing Address - Country:US
Mailing Address - Phone:774-201-1509
Mailing Address - Fax:
Practice Address - Street 1:5 STATE ST
Practice Address - Street 2:APT. 2
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1731
Practice Address - Country:US
Practice Address - Phone:774-201-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health