Provider Demographics
NPI:1669771200
Name:MERCADO, MARILYN (MFTT)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MFTT
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:MERCADO
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTT
Mailing Address - Street 1:6800 OWENSMOUTH AVE
Mailing Address - Street 2:310
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3159
Mailing Address - Country:US
Mailing Address - Phone:818-347-8565
Mailing Address - Fax:818-347-0506
Practice Address - Street 1:6800 OWENSMOUTH AVE
Practice Address - Street 2:310
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3159
Practice Address - Country:US
Practice Address - Phone:818-347-8565
Practice Address - Fax:818-347-0506
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor