Provider Demographics
NPI:1164412482
Name:MERCURIO, LYNN ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANN
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 PAULINE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-3500
Mailing Address - Country:US
Mailing Address - Phone:412-576-6104
Mailing Address - Fax:412-531-8434
Practice Address - Street 1:2143 PAULINE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-3500
Practice Address - Country:US
Practice Address - Phone:412-576-6104
Practice Address - Fax:412-531-8434
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124877OtherHIGHMARK BLUE SHIELD
PA084004Medicare ID - Type Unspecified