Provider Demographics
NPI:1205030236
Name:MERCADO, ROXANNA LORENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:LORENA
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 AVE FD ROOSEVELT
Mailing Address - Street 2:LA TORRE DE PLAZA SUITE 712
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-8001
Mailing Address - Country:US
Mailing Address - Phone:787-345-6410
Mailing Address - Fax:787-759-7875
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:LA TORRE DE PLAZA SUITE 712
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-345-6410
Practice Address - Fax:787-759-7875
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical