Provider Demographics
NPI:1164655460
Name:MARCANO, HERMENEGILDO (MRC)
Entity Type:Individual
Prefix:MR
First Name:HERMENEGILDO
Middle Name:
Last Name:MARCANO
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VISTAS DE RIO GRANDE II ALMACIGO STREET 540
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-8579
Mailing Address - Country:US
Mailing Address - Phone:787-413-8150
Mailing Address - Fax:
Practice Address - Street 1:VISTAS DE RIO GRANDE II ALMACIGO ST. 540
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:SC
Practice Address - Zip Code:00745-8579
Practice Address - Country:US
Practice Address - Phone:787-413-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWCCSS 115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)