Provider Demographics
NPI:1699186700
Name:MERCURIO-RILEY, DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:MERCURIO-RILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3495 BAILEY AVE
Mailing Address - Street 2:VA WESTERN NEW YORK HEALTHCARE SYSTEM 116 B
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1129
Mailing Address - Country:US
Mailing Address - Phone:716-862-8581
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:116 B
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020567103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist