Provider Demographics
NPI:1114982097
Name:CISNEROS-WATSON, MERCEDES PATRICIA (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:PATRICIA
Last Name:CISNEROS-WATSON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 COMMERCE COURT SUITE 300-16
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3698
Mailing Address - Country:US
Mailing Address - Phone:630-505-0103
Mailing Address - Fax:630-933-9474
Practice Address - Street 1:4300 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3698
Practice Address - Country:US
Practice Address - Phone:630-505-0103
Practice Address - Fax:630-933-9474
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health