Provider Demographics
NPI:1851432355
Name:MERCADO, MAYBELLE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAYBELLE
Middle Name:E
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MERRIGAN LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-1573
Mailing Address - Country:US
Mailing Address - Phone:860-593-3657
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 219
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1545
Practice Address - Country:US
Practice Address - Phone:860-909-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4856101YM0800X
CT001795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health