Provider Demographics
NPI:1093264822
Name:MERCADO, MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 DOBBIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2803
Mailing Address - Country:US
Mailing Address - Phone:646-807-9058
Mailing Address - Fax:646-396-0434
Practice Address - Street 1:117 DOBBIN ST STE 210
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2803
Practice Address - Country:US
Practice Address - Phone:646-807-9058
Practice Address - Fax:646-396-0434
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty