Provider Demographics
NPI:1144535147
Name:MERCADO, CARRIE LORE (PHD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LORE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1516 HETHER ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3312
Mailing Address - Country:US
Mailing Address - Phone:513-843-1904
Mailing Address - Fax:
Practice Address - Street 1:1516 HETHER ST UNIT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3312
Practice Address - Country:US
Practice Address - Phone:512-843-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty