Provider Demographics
NPI:1609125996
Name:GARCIA MERCADO, DIMARIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIMARIS
Middle Name:
Last Name:GARCIA MERCADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORREVISTA APARTMENT, APTO 1104
Mailing Address - Street 2:PASEO TRIO VEGABAJENO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00693
Mailing Address - Country:AN
Mailing Address - Phone:787-630-5172
Mailing Address - Fax:
Practice Address - Street 1:#458 JOSE CANALES, SEMINARIO TEOLOGICO DE PR
Practice Address - Street 2:SUITE 01 PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:939-639-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical