Provider Demographics
NPI:1861665978
Name:MERCED, PAUL (MSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MERCED
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 1:1342 COLONIAL BLVD
Mailing Address - Street 2:BLDG.F SUITE 41A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1013
Mailing Address - Country:US
Mailing Address - Phone:239-931-4444
Mailing Address - Fax:239-931-4440
Practice Address - Street 1:1342 COLONIAL BLVD
Practice Address - Street 2:BLDG.F SUITE 41A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1013
Practice Address - Country:US
Practice Address - Phone:239-931-4444
Practice Address - Fax:239-931-4440
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW7171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical