Provider Demographics
NPI:1942606553
Name:MERCEDES, ENMANUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ENMANUEL
Middle Name:
Last Name:MERCEDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 KNOLL TER
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7306
Mailing Address - Country:US
Mailing Address - Phone:201-953-9074
Mailing Address - Fax:
Practice Address - Street 1:526 BLOOMFIELD AVE STE 204
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5525
Practice Address - Country:US
Practice Address - Phone:973-841-4486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist