Provider Demographics
NPI:1821551912
Name:MERCEDES, RICCI MABEL (LMHC)
Entity Type:Individual
Prefix:MS
First Name:RICCI
Middle Name:MABEL
Last Name:MERCEDES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2427
Mailing Address - Country:US
Mailing Address - Phone:914-761-0600
Mailing Address - Fax:914-761-5367
Practice Address - Street 1:156 W 56TH ST STE 1804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3878
Practice Address - Country:US
Practice Address - Phone:212-851-8100
Practice Address - Fax:212-537-0102
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTF66115EMedicaid