Provider Demographics
NPI:1730711805
Name:MERCURIO, ELAINA ROSE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:ROSE
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 REX AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3700
Mailing Address - Country:US
Mailing Address - Phone:215-262-4167
Mailing Address - Fax:
Practice Address - Street 1:8 REX AVE APT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3700
Practice Address - Country:US
Practice Address - Phone:215-262-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001871103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst