Provider Demographics
NPI:1093176216
Name:MERCER, PENELOPE HOLSTEIN (MA, MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:HOLSTEIN
Last Name:MERCER
Suffix:
Gender:F
Credentials:MA, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2409
Mailing Address - Country:US
Mailing Address - Phone:619-316-2107
Mailing Address - Fax:
Practice Address - Street 1:257 ELDER AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-2409
Practice Address - Country:US
Practice Address - Phone:619-316-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist