Provider Demographics
NPI:1457113862
Name:MERCADO COLON, LOREANE (MPSY)
Entity Type:Individual
Prefix:
First Name:LOREANE
Middle Name:
Last Name:MERCADO COLON
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. COLINAS DE SAN FRANCISCO C-26 CALLE GABRIELA
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3031
Mailing Address - Country:US
Mailing Address - Phone:787-484-1239
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO AOR / LOCAL 2-B CALLE BALDORIOTY NORTE #165
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-327-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6513103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling