Provider Demographics
NPI:1659554756
Name:PENA, CARMEN MERCADO (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MERCADO
Last Name:PENA
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:HC 4 BOX 50604
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9665
Mailing Address - Country:US
Mailing Address - Phone:787-381-8220
Mailing Address - Fax:787-862-4043
Practice Address - Street 1:HC 4 BOX 50604
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-9665
Practice Address - Country:US
Practice Address - Phone:787-381-8220
Practice Address - Fax:787-862-4043
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical