Provider Demographics
NPI:1972986040
Name:MERCADO, YAZMIN (PSYD)
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 4206
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9606
Mailing Address - Country:US
Mailing Address - Phone:787-414-6636
Mailing Address - Fax:
Practice Address - Street 1:1135 AVE 65 INFANTERIA
Practice Address - Street 2:STE 17
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3402
Practice Address - Country:US
Practice Address - Phone:787-414-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical