Provider Demographics
NPI:1003041237
Name:KERCADO, ADA I (MED)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:I
Last Name:KERCADO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DE YAUCO CALLE CIRCONIA M3
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-267-4016
Mailing Address - Fax:787-267-4016
Practice Address - Street 1:URB. ESTANCIAS DE YAUCO CALLE CIRCONIA M3
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-2749
Practice Address - Country:US
Practice Address - Phone:787-267-4016
Practice Address - Fax:787-267-4016
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1957103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool