Provider Demographics
NPI:1043934516
Name:MERCADO-RODRIGUEZ, MARIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:MERCADO-RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIEL
Other - Middle Name:
Other - Last Name:MERCADO RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 FALLING WATER DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5218
Mailing Address - Country:US
Mailing Address - Phone:904-881-0486
Mailing Address - Fax:
Practice Address - Street 1:318 FALLING WATER DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-5218
Practice Address - Country:US
Practice Address - Phone:904-881-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSE182171041C0700X
SW182171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty