Provider Demographics
NPI:1518747070
Name:MERCADO MANSILLA, LARISA (BA PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:MERCADO MANSILLA
Suffix:
Gender:F
Credentials:BA PSYCHOLOGIST
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Mailing Address - Street 1:933 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2509
Mailing Address - Country:US
Mailing Address - Phone:413-736-8329
Mailing Address - Fax:
Practice Address - Street 1:80 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-4704
Practice Address - Country:US
Practice Address - Phone:413-846-0445
Practice Address - Fax:413-846-0447
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health