Provider Demographics
NPI:1417169368
Name:MERCADO, LIZ MARIE
Entity Type:Individual
Prefix:MISS
First Name:LIZ
Middle Name:MARIE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DR. CARBONELL CM1
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-453-9443
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO SECTOR EL MEDIO
Practice Address - Street 2:RESIDENCIAL LUIS LLORENS TORRES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913
Practice Address - Country:US
Practice Address - Phone:787-268-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15263104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker