Provider Demographics
NPI:1902552326
Name:MERCADO, SANDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 9 BOX 5252
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9470
Mailing Address - Country:US
Mailing Address - Phone:787-477-0521
Mailing Address - Fax:
Practice Address - Street 1:CARR. 502 KM 4.5
Practice Address - Street 2:BO. QUEBRADA LIMON
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-477-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical