Provider Demographics
NPI:1780246975
Name:FAUSTO, MERCY MARIA (MA LMFT)
Entity type:Individual
Prefix:MRS
First Name:MERCY
Middle Name:MARIA
Last Name:FAUSTO
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:MS
Other - First Name:MERCY
Other - Middle Name:MARIA
Other - Last Name:SOMERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1545 SAINT MARKS PLZ STE 5
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6411
Mailing Address - Country:US
Mailing Address - Phone:209-290-5771
Mailing Address - Fax:
Practice Address - Street 1:1545 SAINT MARKS PLZ STE 5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6411
Practice Address - Country:US
Practice Address - Phone:209-471-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional