Provider Demographics
NPI:1861837999
Name:MERCADO GIUSTI, MARILYN JANISSE (PSY D)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JANISSE
Last Name:MERCADO GIUSTI
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 VILLA DR NW
Mailing Address - Street 2:APT B
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-1958
Mailing Address - Country:US
Mailing Address - Phone:787-672-7127
Mailing Address - Fax:
Practice Address - Street 1:2712 VILLA DR NW
Practice Address - Street 2:APT B
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-1958
Practice Address - Country:US
Practice Address - Phone:787-672-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist