Provider Demographics
NPI:1760991699
Name:MERCADO, MARIAFE AINELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIAFE AINELLE
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AINELLE
Other - Middle Name:
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:110 JEFFERSON BLVD STE E2
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3854
Mailing Address - Country:US
Mailing Address - Phone:401-400-7745
Mailing Address - Fax:401-757-3229
Practice Address - Street 1:110 JEFFERSON BLVD STE E2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3854
Practice Address - Country:US
Practice Address - Phone:401-400-7745
Practice Address - Fax:401-757-3229
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02010103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical