Provider Demographics
NPI:1861895856
Name:MERCURIO, KELLI A (LSW)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:A
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9108
Mailing Address - Country:US
Mailing Address - Phone:973-769-7274
Mailing Address - Fax:
Practice Address - Street 1:416 NORTON RD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-9108
Practice Address - Country:US
Practice Address - Phone:973-769-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012675L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker