Provider Demographics
NPI:1093925596
Name:MERCADO, MARIANA (TS)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-840-2575
Mailing Address - Fax:787-840-8391
Practice Address - Street 1:CENTRO DE SALUD CONDUCTUAL DE MAYAGUEZ
Practice Address - Street 2:HOSP. RAMON EMETERIO BETANCES
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-840-2575
Practice Address - Fax:787-840-8391
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker