Provider Demographics
NPI:1669780094
Name:MERCURIO, KATHRYN
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:MERCURIO
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 1:3047 E MAIN RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4262
Mailing Address - Country:US
Mailing Address - Phone:401-864-0735
Mailing Address - Fax:401-683-6212
Practice Address - Street 1:3047 E MAIN RD STE 6
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4262
Practice Address - Country:US
Practice Address - Phone:401-864-0735
Practice Address - Fax:401-683-6212
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
RIISW023831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical