Provider Demographics
NPI:1528390093
Name:MERCADO, ALFONSO (PHD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7885
Mailing Address - Country:US
Mailing Address - Phone:956-682-0385
Mailing Address - Fax:956-682-0388
Practice Address - Street 1:5109 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7885
Practice Address - Country:US
Practice Address - Phone:956-682-0385
Practice Address - Fax:956-682-0388
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36771103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138708611Medicaid
TX138708610Medicaid
TX216336205Medicaid