Provider Demographics
NPI:1063815900
Name:MERCURIO MARRIAGE AND FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:MERCURIO MARRIAGE AND FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE AND FAMILY THERAP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCURIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-546-4642
Mailing Address - Street 1:271 MADISON AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1001
Mailing Address - Country:US
Mailing Address - Phone:917-546-4642
Mailing Address - Fax:
Practice Address - Street 1:271 MADISON AVE STE 1400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1014
Practice Address - Country:US
Practice Address - Phone:917-546-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty