Provider Demographics
NPI:1861858631
Name:BUERGO, MERCEDES I (RBT/HHA)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:BUERGO
Suffix:I
Gender:F
Credentials:RBT/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17649 SW 142ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2666
Mailing Address - Country:US
Mailing Address - Phone:786-303-0645
Mailing Address - Fax:
Practice Address - Street 1:17649 SW 142ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2666
Practice Address - Country:US
Practice Address - Phone:786-303-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106800900106S00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172A00000XOther Service ProvidersDriver