Provider Demographics
NPI:1760605695
Name:MERCER, GEORGE W (MSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:MERCER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1529
Mailing Address - Country:US
Mailing Address - Phone:505-296-8612
Mailing Address - Fax:
Practice Address - Street 1:1223 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1414
Practice Address - Country:US
Practice Address - Phone:505-343-1918
Practice Address - Fax:505-343-8966
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-059941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical