Provider Demographics
NPI:1295412112
Name:MERCADO LOPEZ, CYNDY IVETTE
Entity type:Individual
Prefix:
First Name:CYNDY
Middle Name:IVETTE
Last Name:MERCADO LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10244 E COLONIAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4365
Mailing Address - Country:US
Mailing Address - Phone:407-202-9440
Mailing Address - Fax:
Practice Address - Street 1:10244 E COLONIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4365
Practice Address - Country:US
Practice Address - Phone:407-202-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst