Provider Demographics
NPI:1063834406
Name:PEREZ MERCADO, FREDDY MANUEL (PHD)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:MANUEL
Last Name:PEREZ MERCADO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COMMERCIAL ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1726
Mailing Address - Country:US
Mailing Address - Phone:508-752-4665
Mailing Address - Fax:508-752-0947
Practice Address - Street 1:250 COMMERCIAL ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1726
Practice Address - Country:US
Practice Address - Phone:508-752-4665
Practice Address - Fax:508-752-0947
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-18
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical