Provider Demographics
NPI:1538680608
Name:MERCADO, LUCIA AILEEN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:AILEEN
Last Name:MERCADO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MR
Other - First Name:LUCIA
Other - Middle Name:AILEEN
Other - Last Name:MERCADO
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4412 KINGSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4404
Mailing Address - Country:US
Mailing Address - Phone:213-304-0458
Mailing Address - Fax:
Practice Address - Street 1:23502 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2535
Practice Address - Country:US
Practice Address - Phone:661-702-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-26738103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst