Provider Demographics
NPI:1093081994
Name:MERCADANTE, TRACY ANNE
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANNE
Last Name:MERCADANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:ANNE
Other - Last Name:MANDELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1406
Practice Address - Country:US
Practice Address - Phone:781-761-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA1004745OtherNHP
MA1004745OtherFALLON
MAM18633OtherBCBS
MA1303287OtherMBHP