Provider Demographics
NPI:1578293502
Name:MACHADO, MERCEDES NICOLE (MSW, CDP)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:NICOLE
Last Name:MACHADO
Suffix:
Gender:F
Credentials:MSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PERCIVAL PATH
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7581
Mailing Address - Country:US
Mailing Address - Phone:406-595-6895
Mailing Address - Fax:
Practice Address - Street 1:714 STONERIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7046
Practice Address - Country:US
Practice Address - Phone:406-848-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical