Provider Demographics
NPI:1750838355
Name:MERCER, RICHARD JR (CASAC-T 25590)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:MERCER
Suffix:JR
Gender:M
Credentials:CASAC-T 25590
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4912
Mailing Address - Country:US
Mailing Address - Phone:845-561-5783
Mailing Address - Fax:845-561-0245
Practice Address - Street 1:172 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4912
Practice Address - Country:US
Practice Address - Phone:845-561-5783
Practice Address - Fax:845-561-0245
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25590101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043385578Medicaid