Provider Demographics
NPI:1932125390
Name:LLENIN, MERCEDES (PHD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:LLENIN
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 1:6262 BIRD RD STE 2F
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4882
Mailing Address - Country:US
Mailing Address - Phone:305-387-7850
Mailing Address - Fax:305-386-0827
Practice Address - Street 1:6262 BIRD RD STE 2F
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4882
Practice Address - Country:US
Practice Address - Phone:305-387-7850
Practice Address - Fax:305-386-0827
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2564101YM0800X, 103K00000X
FLPY6075103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2320AMedicare ID - Type Unspecified