Provider Demographics
NPI:1841478427
Name:MERCADO, DEANNA NICOLE (LMFT, PSYD INTERN)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:NICOLE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LMFT, PSYD INTERN
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:NICOLE
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT-I
Mailing Address - Street 1:4910 E ASHLAN AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3021
Mailing Address - Country:US
Mailing Address - Phone:559-470-7327
Mailing Address - Fax:
Practice Address - Street 1:4910 E ASHLAN AVE STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3021
Practice Address - Country:US
Practice Address - Phone:559-470-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
CA10726106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist