Provider Demographics
NPI:1578624607
Name:MERCURIO, LAUREEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1149
Mailing Address - Country:US
Mailing Address - Phone:516-877-2751
Mailing Address - Fax:
Practice Address - Street 1:626 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1149
Practice Address - Country:US
Practice Address - Phone:516-877-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0267121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113284015OtherTAX IDENTIFICATION NUMBER
NYN43771Medicare ID - Type Unspecified