Provider Demographics
NPI:1720438013
Name:MERCURIO, KAITLYN SCHWARZ (LCSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SCHWARZ
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 OLD FARM RD S
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1507
Mailing Address - Country:US
Mailing Address - Phone:845-242-4175
Mailing Address - Fax:
Practice Address - Street 1:157 OLD FARM RD S
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-1507
Practice Address - Country:US
Practice Address - Phone:845-242-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21810104100000X
NY0905921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker